Healthcare Provider Details

I. General information

NPI: 1891193975
Provider Name (Legal Business Name): SLEEP CONSULTANTS OF ST. LOUIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10199 WOODFIELD LN
OLIVETTE MO
63132-2922
US

IV. Provider business mailing address

777 CRAIG RD SUITE 225
CREVE COEUR MO
63141-7138
US

V. Phone/Fax

Practice location:
  • Phone: 225-303-1055
  • Fax:
Mailing address:
  • Phone: 314-720-2003
  • Fax: 314-594-9033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CARLOS E HIMPLER
Title or Position: CO FOUNDER
Credential:
Phone: 314-720-2003