Provider Demographics
NPI:1023064011
Name:POLK SLEEP DISORDERS LLC
Entity type:Organization
Organization Name:POLK SLEEP DISORDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-299-0302
Mailing Address - Street 1:PO BOX 7272
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33883-7272
Mailing Address - Country:US
Mailing Address - Phone:863-299-0302
Mailing Address - Fax:863-299-0370
Practice Address - Street 1:35 LAKE ELBERT DR.
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3058
Practice Address - Country:US
Practice Address - Phone:863-299-0302
Practice Address - Fax:863-299-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00389765OtherMEDICARE RAILROAD
FLV3161OtherBC FL
P00389765OtherMEDICARE RAILROAD