MEDICARE: KENTUCKY SLEEP DISORDER CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2278P1004X	Pulmonary Diagnostics Certified Respiratory Therapist

General Provider Information

NPI Number	:	1114100617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENTUCKY SLEEP DISORDER CENTER

Provider Business Mailing Address
First Line	:	PO BOX 393
Second Line	:
City	:	LA GRANGE
State	:	KY
Zip	:	40031-0393
Country	:	US
Telephone Number	:	502-222-0330
Fax Number	:	502-222-0390

Provider Business Practice Location Address
First Line	:	1006 NEW MOODY LN
Second Line	:
City	:	LA GRANGE
State	:	KY
Zip	:	40031-9122
Country	:	US
Telephone Number	:	502-222-0330
Fax Number	:	502-222-0390

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	NISHA G DAVE
Credential	:
Telephone Number	:	502-222-0330

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	12/07/2007

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Directions to “KENTUCKY SLEEP DISORDER CENTER ” Practice Location

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