Provider Demographics
NPI:1417378753
Name:GAINESVILLE SLEEP LAB, LLC
Entity Type:Organization
Organization Name:GAINESVILLE SLEEP LAB, LLC
Other - Org Name:SLEEP SPECIALIST SLEEP LAB, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:RRT,RST,RPSGT
Authorized Official - Phone:352-671-9924
Mailing Address - Street 1:1834 SW 1ST AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8100
Mailing Address - Country:US
Mailing Address - Phone:352-671-9924
Mailing Address - Fax:352-671-9925
Practice Address - Street 1:1834 SW 1ST AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8100
Practice Address - Country:US
Practice Address - Phone:352-671-9924
Practice Address - Fax:352-671-9925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GAINESVILLE SLEEP LAB, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9175261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherMEDICARE ID-TYPE UNSPECIFIED
FL302115Medicare UPIN
FLPENDINGOtherMEDICARE ID-TYPE UNSPECIFIED
FLP00308155Medicare UPIN