Organization
ALPHA SLEEP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY S EDWARDS (ADM ASSISTANT)
(601) 296-2552
Entity
Organization
Contact information
Practice address
111 LAMAR AVE, HATTIESBURG, MS 39402
(601) 310-2509
Mailing address
PO BOX 16443, HATTIESBURG, MS 39404-6443
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
17772
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126535
—
MS
01
—
130000227
MEDICARE
—
01
—
311-15-4975A
BLUE CROSS
MS
Enumeration date
07/06/2009
Last updated
07/06/2009
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