Provider Demographics
NPI:1235435140
Name:PREMIER SLEEP CLINIC LLC
Entity Type:Organization
Organization Name:PREMIER SLEEP CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STAMPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-537-9320
Mailing Address - Street 1:2332 STERLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-3044
Mailing Address - Country:US
Mailing Address - Phone:318-537-9320
Mailing Address - Fax:318-537-9323
Practice Address - Street 1:2332 STERLINGTON RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-3044
Practice Address - Country:US
Practice Address - Phone:318-537-9320
Practice Address - Fax:318-537-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD014425173F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Multi-Specialty