Provider Demographics
NPI:1780652115
Name:MIDWEST SLEEP DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:MIDWEST SLEEP DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-227-8787
Mailing Address - Street 1:13975 MANCHESTER RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4500
Mailing Address - Country:US
Mailing Address - Phone:636-227-8787
Mailing Address - Fax:636-227-8610
Practice Address - Street 1:13975 MANCHESTER RD
Practice Address - Street 2:SUITE 9
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63011-4500
Practice Address - Country:US
Practice Address - Phone:636-227-8787
Practice Address - Fax:636-227-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000093019Medicare ID - Type UnspecifiedMEDICARE PART B
MO1237590001Medicare NSC