Provider Demographics
NPI:1295883718
Name:SLEEP SOURCE KENTUCKY, LLC
Entity type:Organization
Organization Name:SLEEP SOURCE KENTUCKY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-575-0080
Mailing Address - Street 1:3125 PARISA DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-4584
Mailing Address - Country:US
Mailing Address - Phone:270-575-0080
Mailing Address - Fax:270-575-0081
Practice Address - Street 1:100 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2000
Practice Address - Country:US
Practice Address - Phone:270-768-0080
Practice Address - Fax:270-768-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3618174400000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9379301OtherMEDICARE PART B #
KY000000324218OtherANTHEM BC/BS
KY000000324218OtherANTHEM BC/BS