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General NPI Number Information
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NPI Number | 1679645907
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Entity Type | Organization
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Legal Business Name | CENTRAL KENTUCKY SLEEP LABS, LLC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 174 PEDRO WAY
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City | WINCHESTER
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State | KY
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Zip | 40391-8354
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Country | US
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Telephone | 859-744-6610
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Fax | 859-744-6618
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Provider Business Mailing Address
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Address Line | 174 PEDRO WAY
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City | WINCHESTER
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State | KY
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Zip | 40391-8354
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Country | US
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Telephone | 859-744-6610
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Fax | 859-744-6618
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Authorized Official
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Title or Position | DIRECTOR
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Name | RALPH A. ALVARADO
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Credential | MD
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Telephone | 859-744-6610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | 730073
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License Number State | KY
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