Madison Sleep Lab, LLC

Primary specialty

Sleep Disorder Diagnostic Clinic/CenterTaxonomy code 261QS1200X

Legal business name

MADISON SLEEP LAB, LLC

Practice address

1883 Highway 43 S
Canton, MS 39046-8405

Phone

(601) 859-0730

Fax

(601) 859-0731

NPI assigned

Nov 15, 2006

Last updated

Mar 20, 2008By 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

Mr. Roland B Wall III

Title

Manager

Phone

(601) 932-3397

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205971200000",
    "number": "1962574749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 INTERSTATE DR",
            "address_2": "STE C",
            "city": "RICHLAND",
            "state": "MS",
            "postal_code": "392184428",
            "telephone_number": "601-932-3397",
            "fax_number": "601-932-3398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1883 HIGHWAY 43 S",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390468405",
            "telephone_number": "601-859-0730",
            "fax_number": "601-859-0731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON SLEEP LAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2008-03-20",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "601-932-3397",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Joel Maier, DPT
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• Mallory Community Health (Dr. Arenia C. Mallory Community Health Center, Inc.)
• Ruth Marie Mann, FNP

• Sleep Disorder Diagnostic Clinic/Center in Canton, MS
• Providers in Canton, MS by specialty
• Sleep Disorder Diagnostic Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.