Organization
CRYSTAL CITY PULMONARY CRITICAL CARE & SLEEP MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH INGRAM CPC (OFFICE MANAGER)
(636) 937-3121
Entity
Organization
Contact information
Practice address
1390 US HIGHWAY 61 STE 2300, FESTUS, MO 63028-4121
(636) 937-3121
(636) 937-4423
Mailing address
4468 SOUTHVIEW WAY DR, SAINT LOUIS, MO 63129-6718
(636) 937-3121
(636) 937-4423
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
2004030200
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207306903
—
MO
05
—
500828603
—
MO
Enumeration date
02/01/2007
Last updated
10/21/2014
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