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General NPI Number Information
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NPI Number | 1487856084
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Entity Type | Organization
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Legal Business Name | SLEEP CONSULTANTS DIAGNOSTIC LAB
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 403 TOWNE CENTER BLVD STE 101A
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City | RIDGELAND
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State | MS
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Zip | 39157-4843
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Country | US
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Telephone | 601-982-7111
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Fax | 601-981-2524
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Provider Business Mailing Address
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Address Line | 403 TOWNE CENTER BLVD STE 101A
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City | RIDGELAND
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State | MS
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Zip | 39157-4843
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Country | US
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Telephone | 601-982-7111
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Fax | 601-981-2524
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Authorized Official
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Title or Position | OWNER
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Name | DR. JULIAN F ROSE
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Credential | MD
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Telephone | 601-982-7111
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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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Taxonomy #2
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | 08416
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 08416
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License Number State | MS
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