=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508625872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOUISIANA SLEEP HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2024
-----------------------------------------------------
Last Update Date | 03/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3511 PARLIAMENT CT
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71303-3135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-434-2227
-----------------------------------------------------
Fax | 337-434-2229
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 BELVIEW RD
-----------------------------------------------------
City | LEESVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71446-2902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-434-2227
-----------------------------------------------------
Fax | 337-434-2229
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MATTHEW S GANEY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 337-239-2509
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------