Provider Demographics
NPI:1083925168
Name:INNOVATIVE SLEEP CENTERS, PLLC
Entity Type:Organization
Organization Name:INNOVATIVE SLEEP CENTERS, PLLC
Other - Org Name:NORTHWEST NEUROLOGY AND MEMORY CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-516-4749
Mailing Address - Street 1:260 LEE ST SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4403
Mailing Address - Country:US
Mailing Address - Phone:360-754-3825
Mailing Address - Fax:360-754-3835
Practice Address - Street 1:260 LEE ST SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4403
Practice Address - Country:US
Practice Address - Phone:360-754-3825
Practice Address - Fax:360-754-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty