Provider Demographics
NPI:1942307772
Name:MEDICAL WEST RESPIRATORY SERVICES, LLC
Entity Type:Organization
Organization Name:MEDICAL WEST RESPIRATORY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-993-7920
Mailing Address - Street 1:9301 DIELMAN INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2204
Mailing Address - Country:US
Mailing Address - Phone:314-993-8100
Mailing Address - Fax:
Practice Address - Street 1:502 W PINE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1426
Practice Address - Country:US
Practice Address - Phone:573-747-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO18411550332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1024042OtherANCILLARY CARE MGT
MO612829OtherHEALTHLINK
MO626100101Medicaid
MO181658OtherBLUECROSS BLUE SHIELD MO
MO626100101Medicaid
MO=========MEDOtherMERCY HEALTH PLAN