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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