Healthcare Provider Details

I. General information

NPI: 1780839340
Provider Name (Legal Business Name): PULMONARY AND SLEEP DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 N 5TH ST STE A
BLYTHEVILLE AR
72315-2404
US

IV. Provider business mailing address

1011 LINWOOD DR
PARAGOULD AR
72450-4861
US

V. Phone/Fax

Practice location:
  • Phone: 870-239-2033
  • Fax:
Mailing address:
  • Phone: 870-239-2033
  • 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: TERESA MELLSTROM
Title or Position: COO
Credential:
Phone: 870-239-2033