Provider Demographics
NPI:1023203932
Name:TUPELO SLEEP DIAGNOSTICS
Entity Type:Organization
Organization Name:TUPELO SLEEP DIAGNOSTICS
Other - Org Name:THE REGGIE WHITE SLEEP DISORDER CENTER - TUPELO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:EVIN
Authorized Official - Last Name:DENMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:901-246-0767
Mailing Address - Street 1:7600 AIRWAYS BLVD.
Mailing Address - Street 2:STE G
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671
Mailing Address - Country:US
Mailing Address - Phone:662-349-9802
Mailing Address - Fax:662-253-0085
Practice Address - Street 1:1150 S. GREEN STREET
Practice Address - Street 2:BLDG. 2, STE B
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4901
Practice Address - Country:US
Practice Address - Phone:662-407-0862
Practice Address - Fax:662-407-0865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512G470007Medicare PIN