Healthcare Provider Details

I. General information

NPI: 1568681211
Provider Name (Legal Business Name): PHYSICIAN'S SLEEP INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 DUSTY LAKE RD. SUITE 204
PINE BLUFF AR
71603
US

IV. Provider business mailing address

1801 W 40TH SUITE 5B
PINE BLUFF AR
71603
US

V. Phone/Fax

Practice location:
  • Phone: 870-879-6571
  • Fax: 870-879-6572
Mailing address:
  • Phone: 870-535-4800
  • Fax: 870-535-4804

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: JACQUELYN SUE FRIGON
Title or Position: PRESIDENT
Credential: MD
Phone: 870-535-4800