Healthcare Provider Details

I. General information

NPI: 1730306192
Provider Name (Legal Business Name): J. L. MILES,DO SLEEP LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 HWY 90
OCEAN SPRINGS MS
39564
US

IV. Provider business mailing address

PO BOX 3590
VICTORIA TX
77903-3590
US

V. Phone/Fax

Practice location:
  • Phone: 228-474-6111
  • Fax: 361-576-4219
Mailing address:
  • Phone: 228-474-6111
  • Fax: 361-576-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number16488
License Number StateMS

VIII. Authorized Official

Name: DR. JANICE L MILES
Title or Position: OWNER
Credential: DO
Phone: 228-474-6111