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Organization

LOUVIERE ENTERPRISES, INC.

Active
Other names
Mid South Sleep Disorders Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. KELIA C INGRAM (OWNER PRESIDENT)
(731) 664-8874
Entity
Organization

Contact information

Practice address
386 CARRIAGE HOUSE DR STE D, JACKSON, TN 38305
(731) 664-8874
(731) 664-8932
Mailing address
386 CARRIAGE HOUSE DR STE D, JACKSON, TN 38305-2236
(731) 664-8874
(731) 664-8932

Taxonomy

Speciality
Code
Description
License number
State
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
2084N0400X
Neurology Physician
261QS1200X
Sleep Disorder Diagnostic Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4218325
BCBS TN
Enumeration date
04/13/2006
Last updated
09/21/2021
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