Provider Demographics
NPI:1659318574
Name:SLEEP DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:SLEEP DIAGNOSTICS, LLC
Other - Org Name:THE REGGIE WHITE SLEEP DISORDER CENTER - DESOTO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:EVIN
Authorized Official - Last Name:DENMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:901-246-0767
Mailing Address - Street 1:7600 AIRWAYS BLVD
Mailing Address - Street 2:STE G
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671
Mailing Address - Country:US
Mailing Address - Phone:662-349-9802
Mailing Address - Fax:669-349-9810
Practice Address - Street 1:7600 AIRWAYS BLVD
Practice Address - Street 2:STE G
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671
Practice Address - Country:US
Practice Address - Phone:662-349-9802
Practice Address - Fax:669-349-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2068261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03003864Medicaid
MS03003864Medicaid
MS470000074Medicare PIN