Organization
SLEEP SOURCE KENTUCKY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK SEXTON (CO-OWNER)
(270) 575-0080
Entity
Organization
Contact information
Practice address
100 N 6TH ST, MURRAY, KY 42071-2000
(270) 768-0080
(270) 768-0081
Mailing address
3125 PARISA DR, PADUCAH, KY 42003-4584
(270) 575-0080
(270) 575-0081
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
3618
KY
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
3618
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000324218
ANTHEM BC/BS
KY
01
—
9379301
MEDICARE PART B #
KY
Enumeration date
01/08/2007
Last updated
05/21/2009
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