Provider Demographics
NPI:1538202221
Name:PULMONARY AND SLEEP DIAGNOSTICS LLC
Entity type:Organization
Organization Name:PULMONARY AND SLEEP DIAGNOSTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CALEB
Authorized Official - Last Name:SAPP
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, RPSGT
Authorized Official - Phone:870-239-2033
Mailing Address - Street 1:PO BOX 856
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-0856
Mailing Address - Country:US
Mailing Address - Phone:870-239-2033
Mailing Address - Fax:870-239-4204
Practice Address - Street 1:607 NORTH TOWN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653
Practice Address - Country:US
Practice Address - Phone:870-424-7033
Practice Address - Fax:870-424-7036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5C152293D00000X
261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C152Medicare ID - Type Unspecified
AR5G205Medicare PIN