Provider Demographics
NPI:1740238591
Name:SOUTHERN SLEEP CLINICS, LLC
Entity Type:Organization
Organization Name:SOUTHERN SLEEP CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LABANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-673-2501
Mailing Address - Street 1:2346 W MAIN ST
Mailing Address - Street 2:STE. 2
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1224
Mailing Address - Country:US
Mailing Address - Phone:334-673-2501
Mailing Address - Fax:334-673-2502
Practice Address - Street 1:2346 W MAIN ST
Practice Address - Street 2:STE. 2
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1224
Practice Address - Country:US
Practice Address - Phone:334-673-2501
Practice Address - Fax:334-673-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12156261QS1200X
AL11900293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51521455OtherBCBS AL
ALY01606Medicare UPIN
AL51521455OtherBCBS AL