Provider Demographics
NPI:1134152176
Name:COMMUNITY SLEEP & DIAGNOSTIC LAB, INC.
Entity type:Organization
Organization Name:COMMUNITY SLEEP & DIAGNOSTIC LAB, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:PORTER
Authorized Official - Last Name:CLAYPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-227-0184
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-0602
Mailing Address - Country:US
Mailing Address - Phone:276-227-0184
Mailing Address - Fax:276-228-8636
Practice Address - Street 1:510 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1093
Practice Address - Country:US
Practice Address - Phone:276-227-0184
Practice Address - Fax:276-228-8636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory