Provider Demographics
NPI:1225493869
Name:USA SLEEP DIAGNOSTIC MOBILE SERVICE
Entity Type:Organization
Organization Name:USA SLEEP DIAGNOSTIC MOBILE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THURLYN
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-792-4445
Mailing Address - Street 1:6030 DAYBREAK CIR
Mailing Address - Street 2:SUITE A150 260
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1642
Mailing Address - Country:US
Mailing Address - Phone:888-792-4445
Mailing Address - Fax:
Practice Address - Street 1:2929 DAMASCUS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4662
Practice Address - Country:US
Practice Address - Phone:910-745-9496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECP-0000085261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic