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Organization
SPACE COAST SLEEP DISORDERS CENTER LLC
Active
Organization
SPACE COAST SLEEP DISORDERS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTONIO EDWIN STIGALL RRT, RPSGT (PRESIDENT/CEO)
(321) 255-9901
Entity
Organization
Contact information
Practice address
640 CLASSIC CT, SUITE 106, MELBOURNE, FL 32940-8279
(321) 255-9901
(321) 255-9902
Mailing address
640 CLASSIC CT, SUITE 106, MELBOURNE, FL 32940-8279
(321) 255-9901
(321) 255-9902
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
HCC7135
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01092537
AMERI GROUP
FL
01
—
1065447
CARE PLUS
FL
01
—
36521
WELLCARE
FL
01
—
7729847
AETNA
FL
01
—
F301267
FREEDOM HEALTH
FL
01
—
V3120
BCBS
FL
Enumeration date
07/19/2006
Last updated
02/28/2017
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