Provider Demographics
NPI:1780839340
Name:PULMONARY AND SLEEP DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:PULMONARY AND SLEEP DIAGNOSTICS LLC
Other - Org Name:FREEDOM SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-239-2033
Mailing Address - Street 1:1011 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4861
Mailing Address - Country:US
Mailing Address - Phone:870-239-2033
Mailing Address - Fax:
Practice Address - Street 1:606 N 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2404
Practice Address - Country:US
Practice Address - Phone:870-239-2033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic