Provider Demographics
NPI:1194027987
Name:SALINE MEMORIAL HOSPITAL TECHNICAL SERVICES LLC
Entity Type:Organization
Organization Name:SALINE MEMORIAL HOSPITAL TECHNICAL SERVICES LLC
Other - Org Name:COULTER SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DON
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-776-6000
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-0834
Practice Address - Street 1:3 MEDICAL PARK DR
Practice Address - Street 2:SUITE 301
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3728
Practice Address - Country:US
Practice Address - Phone:501-315-8818
Practice Address - Fax:501-315-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199836OtherAASM ACCREDITATION