1912936139 NPI number — SLEEP LABS OF THE SOUTH LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912936139 NPI number — SLEEP LABS OF THE SOUTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP LABS OF THE SOUTH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912936139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4318
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37320-4318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-716-7696
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 CLINGAN RIDGE DR NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37312-3652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-716-7696
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOWE
Authorized Official First Name:
DELLA
Authorized Official Middle Name:
MARGARET
Authorized Official Title or Position:
PRESIDENT-MANAGER
Authorized Official Telephone Number:
423-716-7696

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1505658 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4135998 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4204887 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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