MEDICARE: APNEA SLEEP DISORDERS CLINIC, INC.

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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center		TN

General Provider Information

NPI Number	:	1790700664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APNEA SLEEP DISORDERS CLINIC, INC.

Provider Business Mailing Address
First Line	:	3363 N HIGHLAND AVE
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3487
Country	:	US
Telephone Number	:	731-660-4141
Fax Number	:	731-660-4180

Provider Business Practice Location Address
First Line	:	3363 N HIGHLAND AVE
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3487
Country	:	US
Telephone Number	:	731-660-4141
Fax Number	:	731-660-4180

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KEVIN ELGIN
Credential	:
Telephone Number	:	731-660-4141

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/21/2022

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