Organization
SLEEP SOURCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM HOGANCAMP M.D. (CO-OWNER)
(270) 575-0080
Entity
Organization
Contact information
Practice address
3121 PARISA DR, PADUCAH, KY 42003-4584
(270) 575-0080
(270) 575-0081
Mailing address
3121 PARISA DR, PADUCAH, KY 42003-4584
(270) 575-0080
(270) 575-0081
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
0700016509
KY
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000324218
ANTHEM BC/BS #
KY
05
—
65940736
—
KY
01
—
90011586
MEDICAID DME
KY
01
—
9372501
MEDICARE PROVIDER #
KY
01
—
P00168379
RR MEDICARE #
KY
Enumeration date
08/08/2006
Last updated
07/31/2009
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