Provider Demographics
NPI:1588089288
Name:SOUTHAVEN SLEEP CLINIC
Entity type:Organization
Organization Name:SOUTHAVEN SLEEP CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-505-0181
Mailing Address - Street 1:7420 GUTHRIE DR N
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5876
Mailing Address - Country:US
Mailing Address - Phone:662-253-0352
Mailing Address - Fax:662-253-0359
Practice Address - Street 1:7420 GUTHRIE DR N
Practice Address - Street 2:SUITE 110
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5876
Practice Address - Country:US
Practice Address - Phone:662-253-0352
Practice Address - Fax:662-253-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty