Provider Demographics
NPI:1730128315
Name:MIDWEST CENTER FOR SLEEP MEDICINE, LLC
Entity Type:Organization
Organization Name:MIDWEST CENTER FOR SLEEP MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT BOARD OF DIRECTORS
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATHERS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:309-664-3061
Mailing Address - Street 1:1709 JUMER DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-0914
Mailing Address - Country:US
Mailing Address - Phone:309-662-9997
Mailing Address - Fax:309-663-9917
Practice Address - Street 1:1709 JUMER DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704
Practice Address - Country:US
Practice Address - Phone:309-662-9997
Practice Address - Fax:309-663-9917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1200X
ILNA261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205918Medicare PIN