Healthcare Provider Details

I. General information

NPI: 1679645907
Provider Name (Legal Business Name): CENTRAL KENTUCKY SLEEP LABS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 PEDRO WAY
WINCHESTER KY
40391-8354
US

IV. Provider business mailing address

174 PEDRO WAY
WINCHESTER KY
40391-8354
US

V. Phone/Fax

Practice location:
  • Phone: 859-744-6610
  • Fax: 859-744-6618
Mailing address:
  • Phone: 859-744-6610
  • Fax: 859-744-6618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number730073
License Number StateKY

VIII. Authorized Official

Name: RALPH A. ALVARADO
Title or Position: DIRECTOR
Credential: MD
Phone: 859-744-6610