Provider Demographics
NPI:1013219310
Name:WESTERN IDAHO CENTER FOR SLEEP, LLC
Entity Type:Organization
Organization Name:WESTERN IDAHO CENTER FOR SLEEP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DODIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NOLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-488-7715
Mailing Address - Street 1:1673 W SHORELINE DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6750
Mailing Address - Country:US
Mailing Address - Phone:208-342-9800
Mailing Address - Fax:
Practice Address - Street 1:302 E HERSEY ST
Practice Address - Street 2:SUITE 12
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1200
Practice Address - Country:US
Practice Address - Phone:541-488-7715
Practice Address - Fax:541-488-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory