Provider Demographics
NPI:1053686485
Name:THE CENTER FOR SLEEP APNEA AND TMJ PA
Entity Type:Organization
Organization Name:THE CENTER FOR SLEEP APNEA AND TMJ PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMISON
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-376-3600
Mailing Address - Street 1:1436 S EDGEWATER CIR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5051
Mailing Address - Country:US
Mailing Address - Phone:208-376-3600
Mailing Address - Fax:208-376-3616
Practice Address - Street 1:1436 S EDGEWATER CIR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5051
Practice Address - Country:US
Practice Address - Phone:208-376-3600
Practice Address - Fax:208-376-3616
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRANIOFACIAL PAIN CENTER OF IDAHO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies