Provider Demographics
NPI:1558473835
Name:PULMONARY AND SLEEP DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:PULMONARY AND SLEEP DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CALEB
Authorized Official - Last Name:SAPP
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, RPSGT
Authorized Official - Phone:870-239-2033
Mailing Address - Street 1:PO BOX 856
Mailing Address - Street 2:1011 LINWOOD DR
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72451
Mailing Address - Country:US
Mailing Address - Phone:870-239-2033
Mailing Address - Fax:870-239-4204
Practice Address - Street 1:101 W COURT ST STE 1
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4337
Practice Address - Country:US
Practice Address - Phone:870-239-2033
Practice Address - Fax:870-239-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130068716Medicaid
1048140001Medicare ID - Type Unspecified