Provider Demographics
NPI:1871528422
Name:WH SOMNOGRAPHY INC.
Entity type:Organization
Organization Name:WH SOMNOGRAPHY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAKE
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:573-449-0015
Mailing Address - Street 1:503 E NIFONG #223
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201
Mailing Address - Country:US
Mailing Address - Phone:573-449-0015
Mailing Address - Fax:573-449-0189
Practice Address - Street 1:1511 CHAPEL HILL
Practice Address - Street 2:STE 103
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-449-0015
Practice Address - Fax:573-449-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO717504104Medicaid
MO000047020Medicare ID - Type UnspecifiedAREA 01
MO717504104Medicaid
MO000047021Medicare PIN