Provider Demographics
NPI:1902045735
Name:GRENADA DIAGNOSTIC SLEEP CENTER, LLC
Entity Type:Organization
Organization Name:GRENADA DIAGNOSTIC SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:662-226-5747
Mailing Address - Street 1:1300 SUNSET DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4086
Mailing Address - Country:US
Mailing Address - Phone:662-226-5747
Mailing Address - Fax:
Practice Address - Street 1:1300 SUNSET DR
Practice Address - Street 2:SUITE E
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4086
Practice Address - Country:US
Practice Address - Phone:866-981-4262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic