| Advanced Sleep And Gastroenterology Laboratories,inc. | |
|
4206 Technology Dr Ste 2 Modesto CA 95356-8769 | |
| (209) 492-0735 | |
| (209) 579-2354 |
| Full Name | Advanced Sleep And Gastroenterology Laboratories,inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 4206 Technology Dr Ste 2, Modesto, California |
| Authorized Official Name and Position | Jonathan Sam Davidson (CEO) |
| Authorized Official Contact | 2097517165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Sleep And Gastroenterology Laboratories,inc. 262 Burgenland Ave Turlock CA 95382-0343 Ph: (209) 751-7165 | Advanced Sleep And Gastroenterology Laboratories,inc. 4206 Technology Dr Ste 2 Modesto CA 95356-8769 Ph: (209) 492-0735 |
| NPI Number | 1396020947 |
|---|---|
| Provider Enumeration Date | 10/14/2011 |
| Last Update Date | 10/14/2011 |
| Medicare PECOS PAC ID | 8022231018 |
|---|---|
| Medicare Enrollment ID | O20140520001473 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396020947 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| 207RS0012X | Internal Medicine - Sleep Medicine | (* (Not Available)) | Secondary |
| Provider Name | Jonathan Davidson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1295891224 PECOS PAC ID: 1355412842 Enrollment ID: I20091102000219 |
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