Organization Name: | INDIANOLA SLEEP CLINIC, LLC |
NPI Number: | 1104831809 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRIAN K HERRING (MEMBER) |
Mailing Address: | 103 W Jackson St Belzoni |
State: | MS US |
Postal Code: | 390383500 |
Phone Number: | 6628873700 |
Fax Number: | 8885193773 |
NPI Enumeration Date: | 07/30/2006 |
NPI Last Update Date: | 02/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QS1200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Sleep Disorder Diagnostic |
Taxonomy Definition: |