Healthcare Provider Details

I. General information

NPI: 1720463755
Provider Name (Legal Business Name): CARDINAL SLEEP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date: CARDINAL SLEEP LLC 2610 N GLENSTONE AVE SPRINGFIELD MO 65803 2610 N GLENSTONE AVE SPRINGFIELD MO 65803
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 N GLENSTONE AVE
SPRINGFIELD MO
65803-4740
US

IV. Provider business mailing address

2610 N GLENSTONE AVE
SPRINGFIELD MO
65803-4740
US

V. Phone/Fax

Practice location:
  • Phone: 417-719-4267
  • Fax: 417-501-8843
Mailing address:
  • Phone: 417-719-4267
  • Fax: 417-501-8843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. HEATHER ANN MOENKHOFF
Title or Position: OWNER/MANAGER
Credential: RRT, RPSGT
Phone: 417-569-6039