Provider Demographics
NPI:1871971531
Name:DALLAS PULMONARY & SLEEP CLINIC
Entity type:Organization
Organization Name:DALLAS PULMONARY & SLEEP CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNGBAMIGBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-517-4069
Mailing Address - Street 1:1302 BANKSTON LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8676
Mailing Address - Country:US
Mailing Address - Phone:917-517-4069
Mailing Address - Fax:
Practice Address - Street 1:1302 BANKSTON LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8676
Practice Address - Country:US
Practice Address - Phone:917-517-4069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty