Provider Demographics
NPI:1184775074
Name:ADVANCED SLEEP CENTER, INC
Entity type:Organization
Organization Name:ADVANCED SLEEP CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRTAHERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-885-3737
Mailing Address - Street 1:2905 KINGMAN ST
Mailing Address - Street 2:3RD FLOOR, SUITE 3
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-6615
Mailing Address - Country:US
Mailing Address - Phone:504-885-3737
Mailing Address - Fax:504-885-5507
Practice Address - Street 1:2905 KINGMAN ST
Practice Address - Street 2:3RD FLOOR, SUITE 3
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6615
Practice Address - Country:US
Practice Address - Phone:504-885-3737
Practice Address - Fax:504-885-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1314536Medicaid
LA1314536Medicaid
LA=========0OtherBLUE CROSS