Organization
INDIANOLA SLEEP CLINIC, LLC
Active
Other names
Rural Sleep Diagnostics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN K HERRING (MEMBER)
(662) 887-3700
Entity
Organization
Contact information
Practice address
103 W JACKSON ST, BELZONI, MS 39038-3500
(662) 887-3700
(888) 519-3773
Mailing address
PO BOX 1151, MADISON, MS 39130-1151
(662) 887-3700
(888) 519-3773
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05073893
—
MS
01
—
20335479
TRICARE PROVIDER ID
MS
Enumeration date
07/30/2006
Last updated
02/15/2013
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