Provider Demographics
NPI:1720134893
Name:BALLANTYNE SLEEP DIAGNOSTICS
Entity Type:Organization
Organization Name:BALLANTYNE SLEEP DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:E
Authorized Official - Last Name:DENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-346-0767
Mailing Address - Street 1:7600 AIRWAYS BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5138
Mailing Address - Country:US
Mailing Address - Phone:662-349-9802
Mailing Address - Fax:662-349-9810
Practice Address - Street 1:11220 ELM LN
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0715
Practice Address - Country:US
Practice Address - Phone:704-641-5414
Practice Address - Fax:704-523-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory