Healthcare Provider Details

I. General information

NPI: 1790700664
Provider Name (Legal Business Name): APNEA SLEEP DISORDERS CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3363 N HIGHLAND AVE
JACKSON TN
38305-3487
US

IV. Provider business mailing address

3363 N HIGHLAND AVE
JACKSON TN
38305-3487
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-4141
  • Fax: 731-660-4180
Mailing address:
  • Phone: 731-660-4141
  • Fax: 731-660-4180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateTN

VIII. Authorized Official

Name: KEVIN ELGIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 731-660-4141