Provider Demographics
NPI:1265899959
Name:DELTA SLEEP CENTER PLLC
Entity type:Organization
Organization Name:DELTA SLEEP CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHINDER
Authorized Official - Middle Name:P S
Authorized Official - Last Name:TALWAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:731-676-2894
Mailing Address - Street 1:204 ROELLEN RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERN
Mailing Address - State:TN
Mailing Address - Zip Code:38059-4079
Mailing Address - Country:US
Mailing Address - Phone:731-676-2894
Mailing Address - Fax:
Practice Address - Street 1:1505 WOODLAWN AVE STE B
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3145
Practice Address - Country:US
Practice Address - Phone:731-676-2894
Practice Address - Fax:731-334-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21677246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty