Provider Demographics
NPI:1639364458
Name:PEACEFUL SLEEP
Entity Type:Organization
Organization Name:PEACEFUL SLEEP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CORBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-256-8222
Mailing Address - Street 1:304 HIGHWAY 278 E
Mailing Address - Street 2:SUITE C
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-4339
Mailing Address - Country:US
Mailing Address - Phone:662-256-8222
Mailing Address - Fax:662-256-7088
Practice Address - Street 1:304 HIGHWAY 278 E
Practice Address - Street 2:SUITE C
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-4339
Practice Address - Country:US
Practice Address - Phone:662-256-8222
Practice Address - Fax:662-256-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory