Healthcare Provider Details

I. General information

NPI: 1497315493
Provider Name (Legal Business Name): COMMON SLEEP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3246 S NATIONAL AVE
SPRINGFIELD MO
65807-7303
US

IV. Provider business mailing address

3246 S NATIONAL AVE
SPRINGFIELD MO
65807-7303
US

V. Phone/Fax

Practice location:
  • Phone: 417-368-1605
  • Fax: 417-368-1604
Mailing address:
  • Phone: 417-368-1605
  • Fax: 417-368-1604

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: ELIZABETH FERGERSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 417-368-1605