1588089288 NPI number — SOUTHAVEN SLEEP CLINIC

Table of content: MS. MARGO LILY CELESTINO LMP (NPI 1831313410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588089288 NPI number — SOUTHAVEN SLEEP CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHAVEN SLEEP CLINIC
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:
6
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:
1588089288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7420 GUTHRIE DR N
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
SOUTHAVEN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38671-5876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-253-0352
Provider Business Mailing Address Fax Number:
662-253-0359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7420 GUTHRIE DR N
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SOUTHAVEN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38671-5876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-253-0352
Provider Business Practice Location Address Fax Number:
662-253-0359
Provider Enumeration Date:
03/04/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARRELL
Authorized Official First Name:
LORETTA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
901-505-0181

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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