Provider Demographics
NPI:1902077472
Name:SOUTHERN PULMONARY AND SLEEP, LLC
Entity Type:Organization
Organization Name:SOUTHERN PULMONARY AND SLEEP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KNOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-273-3035
Mailing Address - Street 1:101 JUDGE TANNER BLVD
Mailing Address - Street 2:SUITE 506
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7503
Mailing Address - Country:US
Mailing Address - Phone:985-273-3035
Mailing Address - Fax:985-273-3036
Practice Address - Street 1:101 JUDGE TANNER BLVD
Practice Address - Street 2:SUITE 506
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7503
Practice Address - Country:US
Practice Address - Phone:985-273-3035
Practice Address - Fax:985-273-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD-023395207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2366173Medicaid
MS08729581Medicaid
LA1496995Medicaid
MS08729581Medicaid
LA1496995Medicaid