=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740289388
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLEEP DIAGNOSTICS OF WASHINGTON PARISH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2005
-----------------------------------------------------
Last Update Date | 07/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2781 S COLUMBIA RD SUITE A
-----------------------------------------------------
City | BOGALUSA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70427-7961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-735-8579
-----------------------------------------------------
Fax | 985-732-4974
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2781 S COLUMBIA RD SUITE A
-----------------------------------------------------
City | BOGALUSA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70427-7961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-735-8579
-----------------------------------------------------
Fax | 985-732-4974
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | PATRICK G. HOWARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 337-291-9161
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 293D00000X
-----------------------------------------------------
Taxonomy Name | Physiological Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------