Organization
TCSD CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLI M WALL (INSURANCE CONTRACTING SPECIALIST)
(405) 285-4914
Entity
Organization
Contact information
Practice address
3120 W SOUTHLAKE BLVD, SUITE 100, SOUTHLAKE, TX 76092-6783
(817) 741-4521
(817) 741-4279
Mailing address
PO BOX 5576, EDMOND, OK 73083-5576
(405) 285-4914
(405) 285-7127
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
Other
Enumeration date
10/09/2007
Last updated
01/19/2009
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