Provider Demographics
NPI:1700840220
Name:MEMPHIS SLEEP LAB, INC
Entity Type:Organization
Organization Name:MEMPHIS SLEEP LAB, INC
Other - Org Name:SLEEP LABS OF MEMPHIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, RST
Authorized Official - Phone:901-756-4667
Mailing Address - Street 1:382 CARRIAGE HOUSE DR
Mailing Address - Street 2:STE B
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2299
Mailing Address - Country:US
Mailing Address - Phone:731-664-8716
Mailing Address - Fax:731-664-8932
Practice Address - Street 1:1176 VICKERY LN
Practice Address - Street 2:STE 100
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0630
Practice Address - Country:US
Practice Address - Phone:901-756-4667
Practice Address - Fax:901-756-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
3111550OtherBCBS TN
TN1700840220Medicare NSC