Provider Demographics
NPI:1831384072
Name:DIAGNOSTIC SLEEP CENTER
Entity type:Organization
Organization Name:DIAGNOSTIC SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:LEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:423-912-4601
Mailing Address - Street 1:59 GREER LN
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2300
Mailing Address - Country:US
Mailing Address - Phone:606-528-2280
Mailing Address - Fax:
Practice Address - Street 1:59 GREER LN
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2300
Practice Address - Country:US
Practice Address - Phone:606-528-2280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic