Provider Demographics
NPI:1083991772
Name:PACIFIC SLEEP & RESPIRATORY DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:PACIFIC SLEEP & RESPIRATORY DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREL
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:NASPE
Authorized Official - Phone:541-982-4156
Mailing Address - Street 1:1950 WAITE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-1228
Mailing Address - Country:US
Mailing Address - Phone:541-756-9014
Mailing Address - Fax:541-756-9015
Practice Address - Street 1:21 N ADAMS ST
Practice Address - Street 2:
Practice Address - City:COQUILLE
Practice Address - State:OR
Practice Address - Zip Code:97423-1858
Practice Address - Country:US
Practice Address - Phone:541-982-4156
Practice Address - Fax:541-756-9015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC SLEEP & RESPIRATORY DIAGNOSTICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-08
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic