Provider Demographics
NPI:1467796086
Name:SOMNODIAGNOSTICS INCORPORATED
Entity Type:Organization
Organization Name:SOMNODIAGNOSTICS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, RPSGT
Authorized Official - Phone:501-321-0547
Mailing Address - Street 1:106 RIDGEWAY ST
Mailing Address - Street 2:SUITES A AND B
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7100
Mailing Address - Country:US
Mailing Address - Phone:501-321-0547
Mailing Address - Fax:
Practice Address - Street 1:106 RIDGEWAY ST
Practice Address - Street 2:SUITES A AND B
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7100
Practice Address - Country:US
Practice Address - Phone:501-321-0547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146501002Medicaid
AR5C475Medicare UPIN