South Central Regional Sleep Lab

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

SOUTH CENTRAL REGIONAL SLEEP LAB

Practice address

1220 Jefferson St
Laurel, MS 39440-4355

Phone

(601) 426-4530

NPI assigned

Aug 12, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John M. Wallace, M.D.NPI 1174537708

Title

Director

Phone

(601) 426-4530

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• South Central Regional Medical Center

  dba Jones County Rest Home

  • Skilled Nursing Facility
  • Ellisville, MS
  • NPI 1437199213

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John M. Wallace, M.D.

  • Pulmonary Disease Physician
  • Laurel, MS
  • NPI 1174537708
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275545923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6511",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394416511",
            "telephone_number": "601-426-4530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 JEFFERSON ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404355",
            "telephone_number": "601-426-4530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL REGIONAL SLEEP LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-426-4530",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09557052",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Central Regional Medical Center (South Central Internal Medicine Residency Clinic)
• South Central Regional Medical Center (South Central Endocrinology)
• South Central Regional Medical Ctr
• South Central Regional Open MRI, LLC (Open Air MRI of Laurel)
• South Central Regional Sleep Lab
• South Mississippi Home Health, Inc. (Deaconess Hospice)
• South Mississippi Home Health, Inc. - Region I (Deaconess HomeCare)
• Southern Bone & Joint Specialists, PA
• Southern Bone & Joint Specialists, PA
• Southern Eye Surgery and Laser Center, LLC

• Physiological Laboratory in Laurel, MS
• Providers in Laurel, MS by specialty
• Physiological Laboratory in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.