1659461978 NPI number — MIDSOUTH SLEEP DIAGNOSTIC CENTER INC

Table of content: (NPI 1659461978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659461978 NPI number — MIDSOUTH SLEEP DIAGNOSTIC CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDSOUTH SLEEP DIAGNOSTIC CENTER INC
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:
1659461978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1669 KIRBY PKWY STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38120-4397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-316-9888
Provider Business Mailing Address Fax Number:
901-755-8820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1669 KIRBY PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38120-4397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-755-8891
Provider Business Practice Location Address Fax Number:
901-755-8820
Provider Enumeration Date:
10/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AUJLA
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-974-2944

Provider Taxonomy Codes

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

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

  • Identifier: 06300211 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3791251 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com