Provider Demographics
NPI:1083914923
Name:COMPLETE SLEEP SOLUTIONS, INC.
Entity Type:Organization
Organization Name:COMPLETE SLEEP SOLUTIONS, INC.
Other - Org Name:ADVANCED SLEEP DISORDERS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:GOPINATHAN
Authorized Official - Last Name:PATHIAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-472-5163
Mailing Address - Street 1:2397 NE CUMULUS AVENUE
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128
Mailing Address - Country:US
Mailing Address - Phone:503-472-5163
Mailing Address - Fax:
Practice Address - Street 1:749 GOLF VIEW DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9654
Practice Address - Country:US
Practice Address - Phone:541-772-5754
Practice Address - Fax:541-772-5734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18199261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500629618Medicaid