1124080783 NPI number — EMERALD SLEEP DISORDERS CENTER, LLC

Table of content: (NPI 1124080783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124080783 NPI number — EMERALD SLEEP DISORDERS CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERALD SLEEP DISORDERS CENTER, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1124080783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4725 VILLAGE PLAZA LOOP
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97401-6677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-683-3325
Provider Business Mailing Address Fax Number:
541-343-4117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4725 VILLAGE PLAZA LOOP
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-6677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-683-3325
Provider Business Practice Location Address Fax Number:
541-343-4117
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TEARSE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
MEDICAL DIRECTOT
Authorized Official Telephone Number:
541-683-3325

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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