Provider Demographics
NPI:1710904594
Name:CENTRAL ARKANSAS SLEEP DIAGNOSTICS, INC
Entity Type:Organization
Organization Name:CENTRAL ARKANSAS SLEEP DIAGNOSTICS, INC
Other - Org Name:DR. TYRONE T. LEE, CONWAY PULMONOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-327-9532
Mailing Address - Street 1:3700 WEST COLLEGE AVE.
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034
Mailing Address - Country:US
Mailing Address - Phone:501-327-9532
Mailing Address - Fax:501-327-9562
Practice Address - Street 1:3700 WEST COLLEGE AVE.
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034
Practice Address - Country:US
Practice Address - Phone:501-327-9532
Practice Address - Fax:501-327-9562
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONWAY PULMONARY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8126291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARG25773Medicare UPIN
AR5C708Medicare ID - Type Unspecified
AR129608001Medicaid