Provider Demographics
NPI:1619343092
Name:USA SLEEP DIAGNOSTIC MOBILE SERVICES, LLC
Entity Type:Organization
Organization Name:USA SLEEP DIAGNOSTIC MOBILE SERVICES, LLC
Other - Org Name:USA SLEEP DIAGNOSTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THURLYN
Authorized Official - Middle Name:BRYAN
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:888-765-6615
Practice Address - Street 1:1215 ANNAPOLIS RD STE 202
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1349
Practice Address - Country:US
Practice Address - Phone:888-792-4445
Practice Address - Fax:888-765-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084N0400X
VA20179261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty