Provider Demographics
NPI:1386765907
Name:SLEEP DISORDER DIAGNOSTIC CENTER OF SOUTH LOUISIANA, LLC
Entity type:Organization
Organization Name:SLEEP DISORDER DIAGNOSTIC CENTER OF SOUTH LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER & BOARD OF MANAGERS
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:LADD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-876-0300
Mailing Address - Street 1:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-876-5529
Practice Address - Street 1:1053 W TUNNEL BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4079
Practice Address - Country:US
Practice Address - Phone:985-580-2723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic