Provider Demographics
NPI:1851619415
Name:FORT SMITH SLEEP LAB LLC
Entity Type:Organization
Organization Name:FORT SMITH SLEEP LAB LLC
Other - Org Name:DISEASE PREVENTION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-646-2229
Mailing Address - Street 1:4200 JENNY LIND RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-7660
Mailing Address - Country:US
Mailing Address - Phone:479-646-2229
Mailing Address - Fax:479-646-1984
Practice Address - Street 1:4200 JENNY LIND RD
Practice Address - Street 2:SUITE C
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7660
Practice Address - Country:US
Practice Address - Phone:479-646-2229
Practice Address - Fax:479-646-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty