1356729578 NPI number — DOUGLAS MEDICAL EQUIPMENT SUPPLY

Table of content: (NPI 1356729578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356729578 NPI number — DOUGLAS MEDICAL EQUIPMENT SUPPLY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS MEDICAL EQUIPMENT SUPPLY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DBA PACIFIC SLEEP LABS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356729578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1950 WAITE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97459-1228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-756-9014
Provider Business Mailing Address Fax Number:
541-756-9015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
780 2ND ST SE STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANDON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97411-8354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-756-9014
Provider Business Practice Location Address Fax Number:
541-756-9015
Provider Enumeration Date:
05/07/2015

Additional Information

Authorized Official

Authorized Official Last Name:
TORVIK
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ABCT COO
Authorized Official Telephone Number:
541-464-4492

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  500643-94 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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