Provider Demographics
NPI:1790863926
Name:LIMA SLEEP DIAGNOSTIC LAB, LLC
Entity Type:Organization
Organization Name:LIMA SLEEP DIAGNOSTIC LAB, LLC
Other - Org Name:SLEEP CENTER OF LIMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAT
Authorized Official - Middle Name:BABU
Authorized Official - Last Name:KUCHIPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-227-7378
Mailing Address - Street 1:528 W MARKET ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4762
Mailing Address - Country:US
Mailing Address - Phone:419-227-7378
Mailing Address - Fax:419-227-7301
Practice Address - Street 1:528 W MARKET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4762
Practice Address - Country:US
Practice Address - Phone:419-227-7378
Practice Address - Fax:419-227-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2465925Medicaid
OHID01971Medicare PIN