Healthcare Provider Details

I. General information

NPI: 1780652115
Provider Name (Legal Business Name): MIDWEST SLEEP DIAGNOSTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13975 MANCHESTER RD SUITE 9
MANCHESTER MO
63011-4500
US

IV. Provider business mailing address

13975 MANCHESTER RD SUITE 9
MANCHESTER MO
63011-4500
US

V. Phone/Fax

Practice location:
  • Phone: 636-227-8787
  • Fax: 636-227-8610
Mailing address:
  • Phone: 636-227-8787
  • Fax: 636-227-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES E. WALTON
Title or Position: PRESIDENT
Credential:
Phone: 636-227-8787