Provider Demographics
NPI:1396779567
Name:AMERICAN SLEEP DIAGNOSTICS LLC
Entity type:Organization
Organization Name:AMERICAN SLEEP DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JASPER
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:228-897-1636
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-0660
Mailing Address - Country:US
Mailing Address - Phone:228-865-3998
Mailing Address - Fax:228-865-1665
Practice Address - Street 1:106 WILLOW CREEK DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-3311
Practice Address - Country:US
Practice Address - Phone:228-865-3998
Practice Address - Fax:228-865-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0125706Medicaid