Provider Demographics
NPI:1295827137
Name:SLEEP CENTER OF KENTUCKIANA, LLC
Entity Type:Organization
Organization Name:SLEEP CENTER OF KENTUCKIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KHEDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTMAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-964-2440
Mailing Address - Street 1:7926 PRESTON HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3848
Mailing Address - Country:US
Mailing Address - Phone:502-964-2440
Mailing Address - Fax:
Practice Address - Street 1:7926 PRESTON HWY STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3848
Practice Address - Country:US
Practice Address - Phone:502-964-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65946014Medicaid
KY000000509309OtherANTHEM
KY9377501Medicare PIN