# SOUTHERN MISSOURI SLEEP CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124115894
- **Authorized official:** MS. LYNDA NEWMAN (DIRECTOR OF PATIENT CARE)
- **Authorized official phone:** (314) 645-5855

## Contact information

- **Practice address:** 2210 BARRON RD STE 117, POPLAR BLUFF, MO 63901-1922
- **Practice address phone:** (573) 727-9661
- **Practice address fax:** (573) 727-9665
- **Mailing address:** PO BOX 771933, SAINT LOUIS, MO 63177-1933
- **Mailing address phone:** (573) 727-9661

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 293D00000X | Physiological Laboratory | — | — | Yes |

## Other

- **Enumeration date:** 10/06/2006
- **Last updated:** 03/12/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 201634 | BLUE CROSS | MO |
| 05 | — | 716394501 | — | MO |