MEDICARE: MID AMERICA SLEEP SERVICES, 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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1366834152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID AMERICA SLEEP SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2205
Second Line	:
City	:	PLATTE CITY
State	:	MO
Zip	:	64079-2205
Country	:	US
Telephone Number	:	816-291-4574
Fax Number	:	816-841-1357

Provider Business Practice Location Address
First Line	:	2900 WILLIAMSBURG TER
Second Line	:	APT D104
City	:	PLATTE CITY
State	:	MO
Zip	:	64079-7657
Country	:	US
Telephone Number	:	816-291-4574
Fax Number	:	816-841-1357

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. KARI CHAIREZ
Credential	:
Telephone Number	:	816-291-4574

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	03/03/2015

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