Provider Demographics
NPI:1881716306
Name:SOUTHERN SLEEP CLINICS LLC
Entity type:Organization
Organization Name:SOUTHERN SLEEP CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LABANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-791-1700
Mailing Address - Street 1:210 N EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2506
Mailing Address - Country:US
Mailing Address - Phone:334-393-0921
Mailing Address - Fax:334-393-0922
Practice Address - Street 1:210 N EDWARDS ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2506
Practice Address - Country:US
Practice Address - Phone:334-393-0921
Practice Address - Fax:334-393-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALZ16032084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51527354OtherBCBS AL
ALY01606Medicare UPIN
AL051556805Medicare ID - Type Unspecified