Provider Demographics
NPI:1073610341
Name:MISSISSIPPI VALLEY SLEEP DISORDER CENTER LC
Entity Type:Organization
Organization Name:MISSISSIPPI VALLEY SLEEP DISORDER CENTER LC
Other - Org Name:MVSDC-PREMIER SLEEP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS
Authorized Official - Phone:563-322-2036
Mailing Address - Street 1:1230 E RUSHOLME ST
Mailing Address - Street 2:STE 303
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2400
Mailing Address - Country:US
Mailing Address - Phone:563-322-2036
Mailing Address - Fax:563-323-8240
Practice Address - Street 1:242 N BLUFF BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7119
Practice Address - Country:US
Practice Address - Phone:563-242-4233
Practice Address - Fax:563-242-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0469411Medicaid
IA0469411Medicaid