Provider Demographics
NPI:1710903380
Name:SOMNUS SLEEP CLINIC OF CENTRAL MISSISSIPPI, LLC
Entity Type:Organization
Organization Name:SOMNUS SLEEP CLINIC OF CENTRAL MISSISSIPPI, LLC
Other - Org Name:SOMNUS SLEEP CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-939-1808
Mailing Address - Street 1:1006 TREETOPS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7645
Mailing Address - Country:US
Mailing Address - Phone:601-939-1808
Mailing Address - Fax:601-939-3828
Practice Address - Street 1:1006 TREETOPS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7645
Practice Address - Country:US
Practice Address - Phone:601-939-1808
Practice Address - Fax:601-939-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSY47716Medicare UPIN
MS470000071Medicare ID - Type Unspecified