Provider Demographics
NPI:1144686395
Name:LYSEIS HEALTH, LLC
Entity type:Organization
Organization Name:LYSEIS HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:E
Authorized Official - Last Name:HIMPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-303-1055
Mailing Address - Street 1:11477 OLDE CABIN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7129
Mailing Address - Country:US
Mailing Address - Phone:225-303-1055
Mailing Address - Fax:314-594-9004
Practice Address - Street 1:11477 OLDE CABIN RD STE 210
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7129
Practice Address - Country:US
Practice Address - Phone:225-303-1055
Practice Address - Fax:314-594-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295846319OtherOTHER
MO1629159207OtherOTHER