Organization
ADVANCED NEUROSCIENCE CLINIC, PA
Active
Other names
Advanced Sleep Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HAGGERTON (BUSINESS OFFICE MGR.)
(432) 687-6203
Entity
Organization
Contact information
Practice address
601 E 2ND ST STE E, ODESSA, TX 79761-5435
(432) 570-9991
(432) 687-6299
Mailing address
PO BOX 4100, MIDLAND, TX 79704-4100
(432) 570-9991
(432) 687-6299
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
L2914
TX
2084N0400X
Neurology Physician
M3833
TX
2084N0600X
Clinical Neurophysiology Physician
L2914
TX
2084N0600X
Clinical Neurophysiology Physician
M3833
TX
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
L2914
TX
363AM0700X
Medical Physician Assistant
PA04008
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0018HQ
BCBS NUMBER
TX
05
—
149225801
—
TX
Enumeration date
03/01/2007
Last updated
10/08/2024
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