Healthcare Provider Details

I. General information

NPI: 1538202221
Provider Name (Legal Business Name): PULMONARY AND SLEEP DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 NORTH TOWN
MOUNTAIN HOME AR
72653
US

IV. Provider business mailing address

PO BOX 856
PARAGOULD AR
72450-0856
US

V. Phone/Fax

Practice location:
  • Phone: 870-424-7033
  • Fax: 870-424-7036
Mailing address:
  • Phone: 870-239-2033
  • Fax: 870-239-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number5C152
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON CALEB SAPP
Title or Position: CEO
Credential: RRT, RPSGT
Phone: 870-239-2033