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General NPI Number Information
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NPI Number | 1588612543
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Entity Type | Organization
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Legal Business Name | PONTCHARTRAIN SLEEP MEDICINE, LLC
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 802 W 10TH AVE STE 2
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City | COVINGTON
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State | LA
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Zip | 70433-2352
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Country | US
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Telephone | 985-845-1799
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Fax | 985-845-9923
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Provider Business Mailing Address
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Address Line | 802 W 10TH AVE STE 2
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City | COVINGTON
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State | LA
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Zip | 70433-2352
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Country | US
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Telephone | 985-237-0170
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Fax | 985-845-9923
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Authorized Official
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Title or Position | MANAGER
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Name | LAUREN L DAVIS
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Credential | M.D.
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Telephone | 985-845-1799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD.020713
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License Number State | LA
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