Provider Demographics
NPI:1912090523
Name:ILLINOIS SLEEP INSTITUTE, LLC
Entity Type:Organization
Organization Name:ILLINOIS SLEEP INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-645-5855
Mailing Address - Street 1:105 AIRWAY DR.
Mailing Address - Street 2:STE. 3
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:63959-5872
Mailing Address - Country:US
Mailing Address - Phone:618-997-5500
Mailing Address - Fax:
Practice Address - Street 1:105 AIRWAY DR.
Practice Address - Street 2:STE. 3
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:63959-5872
Practice Address - Country:US
Practice Address - Phone:618-997-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212587Medicare ID - Type Unspecified