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General NPI Number Information
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NPI Number | 1104831809
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Entity Type | Organization
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Legal Business Name | INDIANOLA SLEEP CLINIC, LLC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 103 W JACKSON ST
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City | BELZONI
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State | MS
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Zip | 39038-3500
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Country | US
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Telephone | 662-887-3700
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Fax | 888-519-3773
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Provider Business Mailing Address
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Address Line | PO BOX 1151
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City | MADISON
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State | MS
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Zip | 39130-1151
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Country | US
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Telephone | 662-887-3700
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Fax | 888-519-3773
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Authorized Official
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Title or Position | MEMBER
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Name | MR. BRIAN K HERRING
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Credential |
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Telephone | 662-887-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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