Provider Demographics
NPI:1932283355
Name:LION SLEEP LABS INC
Entity Type:Organization
Organization Name:LION SLEEP LABS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-692-4945
Mailing Address - Street 1:1 GINGER CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3537
Mailing Address - Country:US
Mailing Address - Phone:618-692-4945
Mailing Address - Fax:618-692-4975
Practice Address - Street 1:1 GINGER CREEK PKWY
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3537
Practice Address - Country:US
Practice Address - Phone:618-692-4945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
421849284003OtherTRICARE
MO470000719OtherMEDICARE RAILROAD
124960OtherBCBS OF MO
421849284002OtherTRICARE
40878OtherHEALTHCARE USA
432677OtherHEALTHLINK
38314OtherGHP
0006032060OtherBCBS OF IL
MO470000719OtherMEDICARE RAILROAD
IL207264Medicare PIN
432677OtherHEALTHLINK
40878OtherHEALTHCARE USA