Provider Demographics
NPI:1104856558
Name:AMERICAN SLEEP MEDICINE
Entity Type:Organization
Organization Name:AMERICAN SLEEP MEDICINE
Other - Org Name:ST LOUIS SLEEP CENTER LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SERVICE CENTER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOCEYUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-417-5536
Mailing Address - Street 1:7900 BELFORT PKWY
Mailing Address - Street 2:STE 301
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6978
Mailing Address - Country:US
Mailing Address - Phone:904-562-5811
Mailing Address - Fax:904-517-5501
Practice Address - Street 1:727 CRAIG RD
Practice Address - Street 2:STE 101
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7175
Practice Address - Country:US
Practice Address - Phone:314-994-9499
Practice Address - Fax:314-991-6844
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN SLEEP MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-03
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1104856558Medicaid