NPIMap

Organization Active NPI

St Louis Sinus & Sleep Centers, LLC

  • Sleep Disorder Diagnostic Clinic/Center
  • Waterloo, IL
National Provider Identifier
1629414644
Registry record updated May 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Disorder Diagnostic Clinic/CenterTaxonomy code 261QS1200X
License
036101869 Issued in IL
Legal business name
ST LOUIS SINUS & SLEEP CENTERS, LLC
Practice address
509 Hamacher St
Suite 205
Waterloo, IL 62298-1592
Phone
(618) 939-4368
Fax
(888) 371-4468
NPI assigned
May 16, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ketan A Shah, M.D.NPI 1841306693
Title
Owner
Phone
(618) 939-4368

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Disorder Diagnostic Clinic/Center 261QS1200X 036101869 IL Primary

Addresses

Primary practice location

509 Hamacher St
Suite 205
Waterloo, IL 62298-1592

Mailing address

1167 Fortune Blvd
Shiloh, IL 62269-7377
Phone (618) 628-0715

National Provider Directory

National Provider Directory

Locations

509 Hamacher St
Ste 205
Waterloo, IL 62298
Phone (618) 939-4368

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1368662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368662400000",
    "number": "1629414644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1167 FORTUNE BLVD",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622697377",
            "telephone_number": "618-628-0715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 HAMACHER ST",
            "address_2": "SUITE 205",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981592",
            "telephone_number": "618-939-4368",
            "fax_number": "888-371-4468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LOUIS SINUS & SLEEP CENTERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-16",
        "last_updated": "2013-05-16",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "KETAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-939-4368",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": "IL",
            "license": "036101869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.