MEDICARE: SLEEP KWEST, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory		MO

General Provider Information

NPI Number	:	1235194002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP KWEST, LLC

Provider Business Mailing Address
First Line	:	101B PROGRESS PKWY
Second Line	:
City	:	SULLIVAN
State	:	MO
Zip	:	63080-2359
Country	:	US
Telephone Number	:	573-860-4004
Fax Number	:	573-860-4003

Provider Business Practice Location Address
First Line	:	101B PROGRESS PKWY
Second Line	:
City	:	SULLIVAN
State	:	MO
Zip	:	63080-2359
Country	:	US
Telephone Number	:	573-860-4004
Fax Number	:	573-860-4003

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHIRON MATLOCK
Credential	:	RPSGT/RMLT
Telephone Number	:	573-860-4004

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	08/22/2020

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