Organization
IMA SLEEP INSTITUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOWELL TESKA (ADMINISTRATOR)
(260) 969-7100
Entity
Organization
Contact information
Practice address
1625 MAGNAVOX WAY, FORT WAYNE, IN 46804-1535
(866) 363-7535
(866) 363-7534
Mailing address
7900 W JEFFERSON BLVD, SUITE 201, FORT WAYNE, IN 46804-4128
(260) 969-7100
(260) 969-7101
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200817600
—
IN
Enumeration date
06/19/2006
Last updated
01/05/2010
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