MEDICARE: JOHNSTON SLEEP DISORDERS CENTER LLC

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	246Z00000X	Other Specialist/Technologist	246Z00000X	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00247505	OTHER	NC	MEDICARE RAILROAD NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	015M7	OTHER	NC	BCBS OF NC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205876521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSTON SLEEP DISORDERS CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 3997
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27895-3997
Country	:	US
Telephone Number	:	919-202-0023
Fax Number	:	919-202-0010

Provider Business Practice Location Address
First Line	:	115 E OAK ST
Second Line	:
City	:	SELMA
State	:	NC
Zip	:	27576-2845
Country	:	US
Telephone Number	:	919-202-0023
Fax Number	:	919-202-0010

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. LINDSEY ELLIOT DEGUEHERY
Credential	:	MD
Telephone Number	:	919-202-0023

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	11/30/2007

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