Healthcare Provider Details

I. General information

NPI: 1487139754
Provider Name (Legal Business Name): SLEEP WELL STL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 GRAVOIS RD
HIGH RIDGE MO
63049-2508
US

IV. Provider business mailing address

2690 GRAVOIS RD
HIGH RIDGE MO
63049-2508
US

V. Phone/Fax

Practice location:
  • Phone: 314-401-1878
  • Fax:
Mailing address:
  • Phone: 314-401-1878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: NATHAN HARTMAN
Title or Position: OWNER
Credential:
Phone: 314-401-1878