Provider Demographics
NPI:1124115894
Name:SOUTHERN MISSOURI SLEEP CENTER, LLC
Entity type:Organization
Organization Name:SOUTHERN MISSOURI SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-645-5855
Mailing Address - Street 1:PO BOX 771933
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63177-1933
Mailing Address - Country:US
Mailing Address - Phone:573-727-9661
Mailing Address - Fax:
Practice Address - Street 1:2210 BARRON RD STE 117
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-1922
Practice Address - Country:US
Practice Address - Phone:573-727-9661
Practice Address - Fax:573-727-9665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201634OtherBLUE CROSS
MO716394501Medicaid
MO716394501Medicaid