Provider Demographics
NPI:1528115508
Name:BULLITT COUNTY SLEEP DISORDRS LAB
Entity type:Organization
Organization Name:BULLITT COUNTY SLEEP DISORDRS LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:H
Authorized Official - Last Name:HACK
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:502-957-0317
Mailing Address - Street 1:815 JOHN HARPER RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7463
Mailing Address - Country:US
Mailing Address - Phone:502-957-0317
Mailing Address - Fax:502-957-0323
Practice Address - Street 1:815 JOHN HARPER RD
Practice Address - Street 2:SUITE 6
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7463
Practice Address - Country:US
Practice Address - Phone:502-957-0317
Practice Address - Fax:502-957-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1130247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty