Provider Demographics
NPI:1194144261
Name:MIDWEST SLEEP LAB LLC
Entity type:Organization
Organization Name:MIDWEST SLEEP LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-760-1501
Mailing Address - Street 1:555 W PINE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1439
Mailing Address - Country:US
Mailing Address - Phone:573-760-1501
Mailing Address - Fax:
Practice Address - Street 1:555 W PINE ST STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1439
Practice Address - Country:US
Practice Address - Phone:573-760-1501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic