Organization
PRIME SLEEP SERVICES GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK GARDNER MD (OWNER)
(214) 537-8039
Entity
Organization
Contact information
Practice address
6401 ELDORADO PKWY, 304, MCKINNEY, TX 75070-5887
(214) 620-2057
(214) 620-2058
Mailing address
6401 ELDORADO PKWY, 304, MCKINNEY, TX 75070-5887
(214) 620-2057
(214) 620-2058
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
100912
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100912
DEVICE DISTRIBUTOR LICENSE
TX
Enumeration date
06/29/2012
Last updated
06/29/2012
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