Provider Demographics
NPI:1124277322
Name:FORT SMITH SLEEP LAB, LLC
Entity type:Organization
Organization Name:FORT SMITH SLEEP LAB, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIO
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESPINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-646-2229
Mailing Address - Street 1:4200 JENNY LIND RD STE C
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-7632
Mailing Address - Country:US
Mailing Address - Phone:479-646-2229
Mailing Address - Fax:479-646-1984
Practice Address - Street 1:4200 JENNY LIND RD STE C
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7632
Practice Address - Country:US
Practice Address - Phone:479-646-2229
Practice Address - Fax:479-646-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR181284002Medicaid