Healthcare Provider Details

I. General information

NPI: 1306863246
Provider Name (Legal Business Name): SKAGGZZZ SLEEP INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1269 DOCTORS DR
FARMINGTON MO
63640-2947
US

IV. Provider business mailing address

1269 DOCTORS DR
FARMINGTON MO
63640-2947
US

V. Phone/Fax

Practice location:
  • Phone: 573-760-1501
  • Fax: 573-760-1531
Mailing address:
  • Phone: 573-760-1501
  • Fax: 573-760-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERESA MICHELE SKAGGS
Title or Position: PRESIDENT
Credential:
Phone: 573-760-1501