Provider Demographics
NPI:1992834642
Name:GAINESVILLE SLEEP LAB, LLC
Entity type:Organization
Organization Name:GAINESVILLE SLEEP LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMNER
Authorized Official - Suffix:
Authorized Official - Credentials:RRT,RPSGT
Authorized Official - Phone:352-732-5552
Mailing Address - Street 1:PO BOX 1317
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-1317
Mailing Address - Country:US
Mailing Address - Phone:352-732-5552
Mailing Address - Fax:352-732-1131
Practice Address - Street 1:9200 NW 36TH PL
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7348
Practice Address - Country:US
Practice Address - Phone:352-732-5552
Practice Address - Fax:352-732-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016061200Medicaid
FLV0398OtherBCBS
FLU6802BMedicare PIN
FLV0398OtherBCBS
FL302115Medicare UPIN