Organization
SLEEP SOURCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM HOGANCAMP M.D. (MEDICAL DIRECTOR)
(270) 575-0080
Entity
Organization
Contact information
Practice address
585 WESTPORT RD # C, ELIZABETHTOWN, KY 42701-2949
(270) 234-0999
Mailing address
3125 PARISA DR, PADUCAH, KY 42003-4584
(270) 575-0080
(270) 575-0081
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
15166
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000324218
ANTHEM BC/BS
KY
01
—
5316100003
MEDICARE DME
KY
Enumeration date
01/08/2007
Last updated
10/24/2007
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