1306872965 NPI number — SOMNO DIAGNOSTICS, 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 1306872965 NPI number — SOMNO DIAGNOSTICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOMNO DIAGNOSTICS, 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:
1306872965
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1775
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70470-1775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-727-7900
Provider Business Mailing Address Fax Number:
985-727-7333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16061 DOCTORS BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-727-7900
Provider Business Practice Location Address Fax Number:
985-727-7333
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
MADELEINE
Authorized Official Middle Name:
MULA
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
985-727-7900

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2348507 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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