=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376942979
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMFORT HOME SLEEP TEST CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2014
-----------------------------------------------------
Last Update Date | 08/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2150 W POPLAR AVE STE 106
-----------------------------------------------------
City | COLLIERVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38017-0625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-854-4426
-----------------------------------------------------
Fax | 901-854-8063
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2150 W POPLAR AVE STE 106
-----------------------------------------------------
City | COLLIERVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38017-0625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-854-4426
-----------------------------------------------------
Fax | 901-854-8063
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEVE THOMPSON
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 901-854-4426
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS3821
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------