1124135165 NPI number — CONFLUENCE SLEEP & PULMONARY LLC

Table of content: (NPI 1124135165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124135165 NPI number — CONFLUENCE SLEEP & PULMONARY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONFLUENCE SLEEP & PULMONARY 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:
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:
1124135165
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 SAINT JOHNS WAY
Provider Second Line Business Mailing Address:
SUITE 16
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83501-2435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-746-8600
Provider Business Mailing Address Fax Number:
208-746-8604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 SAINT JOHNS WAY
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83501-2435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-746-8600
Provider Business Practice Location Address Fax Number:
208-746-8604
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PLUTO
Authorized Official First Name:
LUKE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-746-8600

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000010158930 . This is a "REGENCE BLUESHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 0215165 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1123389 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF4584 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 804124700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: B5650 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com