Provider Demographics
NPI:1659461978
Name:MIDSOUTH SLEEP DIAGNOSTIC CENTER INC
Entity type:Organization
Organization Name:MIDSOUTH SLEEP DIAGNOSTIC CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUJLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-974-2944
Mailing Address - Street 1:1669 KIRBY PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-4397
Mailing Address - Country:US
Mailing Address - Phone:901-316-9888
Mailing Address - Fax:901-755-8820
Practice Address - Street 1:1669 KIRBY PARKWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4397
Practice Address - Country:US
Practice Address - Phone:901-755-8891
Practice Address - Fax:901-755-8820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-15
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06300211Medicaid
TN3791251Medicaid
MS06300211Medicaid
TN3791251Medicare ID - Type UnspecifiedMEDICARE
TN7662654Medicare UPIN
TN3791251Medicaid