Provider Demographics
NPI:1013033356
Name:LAKESHORE SLEEP DISORDER CENTER, LLC
Entity Type:Organization
Organization Name:LAKESHORE SLEEP DISORDER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP OF CORPORATE DEVELOPMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:H
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-414-7525
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35502-0689
Mailing Address - Country:US
Mailing Address - Phone:205-221-8200
Mailing Address - Fax:
Practice Address - Street 1:1280 COLUMBIANA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-1642
Practice Address - Country:US
Practice Address - Phone:205-945-6711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic