Provider Demographics
NPI:1265496780
Name:SLEEP LABS OF HAMMOND LLC
Entity Type:Organization
Organization Name:SLEEP LABS OF HAMMOND LLC
Other - Org Name:HAMMOND SLEEP DISORDERS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-345-2009
Mailing Address - Street 1:382 B CARRIAGE HOUSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2299
Mailing Address - Country:US
Mailing Address - Phone:731-664-8716
Mailing Address - Fax:731-664-8932
Practice Address - Street 1:1200 DEREK DRIVE
Practice Address - Street 2:STE. 400
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5763
Practice Address - Country:US
Practice Address - Phone:985-345-2009
Practice Address - Fax:985-345-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DA5OOtherMEDICARE PTAN
G6954OtherBCBS LA