Provider Demographics
NPI:1902511454
Name:ELLIS SLEEP CENTER LLC
Entity Type:Organization
Organization Name:ELLIS SLEEP CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-210-5150
Mailing Address - Street 1:10296 BIG BEND RD STE 207
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6582
Mailing Address - Country:US
Mailing Address - Phone:314-965-1334
Mailing Address - Fax:
Practice Address - Street 1:10296 BIG BEND RD STE 207
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6582
Practice Address - Country:US
Practice Address - Phone:314-965-1334
Practice Address - Fax:314-965-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies