Healthcare Provider Details

I. General information

NPI: 1972808673
Provider Name (Legal Business Name): PREMIER SLEEP CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2332 STERLINGTON RD
MONROE LA
71203-3044
US

IV. Provider business mailing address

2332 STERLINGTON RD
MONROE LA
71203-3044
US

V. Phone/Fax

Practice location:
  • Phone: 318-537-9320
  • Fax: 318-537-9323
Mailing address:
  • Phone: 318-537-9320
  • Fax: 318-537-9323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY MICHAEL STAMPER
Title or Position: OWNER
Credential:
Phone: 318-537-9320