Provider Demographics
NPI:1407075302
Name:J L MILES, DO SLEEP LAB
Entity Type:Organization
Organization Name:J L MILES, DO SLEEP LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:228-474-6111
Mailing Address - Street 1:PO BOX 3590
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3590
Mailing Address - Country:US
Mailing Address - Phone:361-576-3680
Mailing Address - Fax:361-576-4219
Practice Address - Street 1:3418 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-5102
Practice Address - Country:US
Practice Address - Phone:228-474-6111
Practice Address - Fax:361-576-4219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16488207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF73267Medicare UPIN