Provider Demographics
NPI:1760504344
Name:GULF COAST COMPREHENSIVE SLEEP MEDICINE CENTER
Entity type:Organization
Organization Name:GULF COAST COMPREHENSIVE SLEEP MEDICINE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER TECHNICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-764-1441
Mailing Address - Street 1:1972 ORMOND BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-3818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1972 ORMOND BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-3818
Practice Address - Country:US
Practice Address - Phone:985-764-1441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory