Provider Demographics
NPI:1811144017
Name:SEMO QUALITY SLEEP LAB LLC
Entity type:Organization
Organization Name:SEMO QUALITY SLEEP LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-452-6794
Mailing Address - Street 1:1417 N MOUNT AUBURN RD
Mailing Address - Street 2:STE C
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2171
Mailing Address - Country:US
Mailing Address - Phone:573-888-6600
Mailing Address - Fax:573-888-6655
Practice Address - Street 1:1417 N MOUNT AUBURN RD
Practice Address - Street 2:STE C
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2171
Practice Address - Country:US
Practice Address - Phone:573-888-6600
Practice Address - Fax:573-888-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic