MEDICARE: SERENITY SLEEP LAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1427256882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY SLEEP LAB LLC

Provider Business Mailing Address
First Line	:	1525 HUNT CLUB BLVD.
Second Line	:	SUITE 100
City	:	GALLATIN
State	:	TN
Zip	:	37066
Country	:	US
Telephone Number	:	615-989-1024
Fax Number	:	615-989-1061

Provider Business Practice Location Address
First Line	:	1525 HUNT CLUB BLVD STE 100
Second Line	:
City	:	GALLATIN
State	:	TN
Zip	:	37066-6070
Country	:	US
Telephone Number	:	615-989-1024
Fax Number	:	615-989-1061

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. VICTOR S. PRICE
Credential	:	RPSGT,RRT
Telephone Number	:	615-989-1024

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	08/19/2011

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