=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497784201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLEEP DIAGNOSTICS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 09/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 YOUREE DR SUITE 110
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71104-3661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-861-7533
-----------------------------------------------------
Fax | 318-861-7534
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2800 YOUREE DR SUITE 110
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71104-3661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-861-7533
-----------------------------------------------------
Fax | 318-861-7534
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | JAMES STEVEN PROCELL
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 318-861-7533
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number | N/A
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------