Provider Demographics
NPI:1609831148
Name:CENTER FOR CARDIAC SLEEP MEDICINE LLC
Entity type:Organization
Organization Name:CENTER FOR CARDIAC SLEEP MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-815-7804
Mailing Address - Street 1:10720 SIKES PL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8141
Mailing Address - Country:US
Mailing Address - Phone:704-815-7789
Mailing Address - Fax:888-401-6931
Practice Address - Street 1:64040 HIGHWAY 434
Practice Address - Street 2:SUITE 102
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-3456
Practice Address - Country:US
Practice Address - Phone:985-882-9200
Practice Address - Fax:985-882-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00350498OtherRR MEDICARE
LAP00350498OtherRR MEDICARE