Provider Demographics
NPI:1508233032
Name:USA SLEEP DIAGNOSTIC MOBILE SERVICES, LLC
Entity Type:Organization
Organization Name:USA SLEEP DIAGNOSTIC MOBILE SERVICES, LLC
Other - Org Name:USA SLEEP DIAGNOSTIC MOBILE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THURLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-792-4445
Mailing Address - Street 1:6030 DAYBREAK CIR STE A150260
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1642
Mailing Address - Country:US
Mailing Address - Phone:888-792-4445
Mailing Address - Fax:888-226-4773
Practice Address - Street 1:392 GARRISONVILLE RD STE 210B
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1500
Practice Address - Country:US
Practice Address - Phone:888-792-4445
Practice Address - Fax:888-226-4773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20179261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic