Provider Demographics
NPI:1487828893
Name:REST EASY OF ST LOUIS, LLC
Entity Type:Organization
Organization Name:REST EASY OF ST LOUIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-767-9864
Mailing Address - Street 1:5231 BRITTANY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9143
Mailing Address - Country:US
Mailing Address - Phone:225-767-9864
Mailing Address - Fax:225-769-5008
Practice Address - Street 1:13421 MANCHESTER RD
Practice Address - Street 2:STE. 107
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-1740
Practice Address - Country:US
Practice Address - Phone:225-303-1055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic