Organization
LAKESIDE SLEEP CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORTNIE WELLMAN (OWNER)
(936) 582-1112
Entity
Organization
Contact information
Practice address
123 BLUE HERON DR, STE 102, MONTGOMERY, TX 77316-3192
(936) 582-1112
Mailing address
123 BLUE HERON DR, STE 102, MONTGOMERY, TX 77316-3192
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
TX
332BX2000X
Oxygen Equipment & Supplies (DME)
1000226
TX
Other
Enumeration date
01/10/2017
Last updated
01/10/2017
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