MEDICARE: MEDICAL WEST RESPIRATORY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	18411550	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	612829	OTHER	MO	HEALTHLINK
2	181658	OTHER	MO	BLUECROSS BLUE SHIELD MO
3	1616644634MED	OTHER	MO	MERCY

General Provider Information

NPI Number	:	1063556058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL WEST RESPIRATORY SERVICES, LLC

Provider Business Mailing Address
First Line	:	9301 DIELMAN INDUSTRIAL DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1381 HIGH ST
Second Line	:	SUITE 101
City	:	WASHINGTON
State	:	MO
Zip	:	63090-6446
Country	:	US
Telephone Number	:	636-390-4040
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	KENNETH A SANDLER
Credential	:
Telephone Number	:	314-993-7920

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	02/05/2015

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