Provider Demographics
NPI:1912936139
Name:SLEEP LABS OF THE SOUTH LLC
Entity type:Organization
Organization Name:SLEEP LABS OF THE SOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-716-7696
Mailing Address - Street 1:PO BOX 4318
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37320-4318
Mailing Address - Country:US
Mailing Address - Phone:423-716-7696
Mailing Address - Fax:
Practice Address - Street 1:1600 CLINGAN RIDGE DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3652
Practice Address - Country:US
Practice Address - Phone:423-716-7696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1505658Medicaid
TN4135998OtherBCBS
TN4204887OtherBCBS
TN1505658Medicaid