Provider Demographics
NPI:1811901366
Name:LOUISIANA SLEEP DIAGNOSTICS LLC
Entity type:Organization
Organization Name:LOUISIANA 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:228-865-3998
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:WATSON
Mailing Address - State:LA
Mailing Address - Zip Code:70786-0180
Mailing Address - Country:US
Mailing Address - Phone:337-289-0241
Mailing Address - Fax:337-289-0243
Practice Address - Street 1:2020 W PINHOOK RD
Practice Address - Street 2:SUITE 303
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3290
Practice Address - Country:US
Practice Address - Phone:337-289-0241
Practice Address - Fax:337-289-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF8022OtherBLUE CROSSW/BLUE SHIELD
LAF8022OtherBLUE CROSSW/BLUE SHIELD