Healthcare Provider Details

I. General information

NPI: 1013033356
Provider Name (Legal Business Name): LAKESHORE SLEEP DISORDER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 COLUMBIANA RD SUITE 102
BIRMINGHAM AL
35216-1642
US

IV. Provider business mailing address

PO BOX 689
JASPER AL
35502-0689
US

V. Phone/Fax

Practice location:
  • Phone: 205-945-6711
  • Fax:
Mailing address:
  • Phone: 205-221-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEWART H PACE
Title or Position: SR VP OF CORPORATE DEVELOPMENT
Credential:
Phone: 205-414-7525