# SLEEP SOURCE KENTUCKY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720232796
- **Authorized official:** MARK SEXTON (CO-OWNER)
- **Authorized official phone:** (270) 575-0080

## Contact information

- **Practice address:** 3125 PARISA DR, PADUCAH, KY 42003-4584
- **Practice address phone:** (270) 575-0080
- **Practice address fax:** (270) 575-0081
- **Mailing address:** 3125 PARISA DRIVE, PADUCAH, KY 42003-4584
- **Mailing address phone:** (270) 575-0080
- **Mailing address fax:** (270) 575-0081

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QS1200X | Sleep Disorder Diagnostic Clinic/Center | 730079 | KY | Yes |

## Other

- **Enumeration date:** 11/04/2008
- **Last updated:** 11/10/2009