Provider Demographics
NPI:1124202668
Name:PRIORITY SLEEP DIAGNOSTIC CENTER LLC
Entity type:Organization
Organization Name:PRIORITY SLEEP DIAGNOSTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEREE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, BRPT
Authorized Official - Phone:901-596-1812
Mailing Address - Street 1:3650 SOUTHWIND PARK COVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125
Mailing Address - Country:US
Mailing Address - Phone:901-753-6212
Mailing Address - Fax:901-759-0309
Practice Address - Street 1:3650 SOUTHWIND PARK COVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125
Practice Address - Country:US
Practice Address - Phone:901-753-6212
Practice Address - Fax:901-759-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory