Provider Demographics
NPI:1255483087
Name:2ND WIND SLEEP MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:2ND WIND SLEEP MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:503-485-2552
Mailing Address - Street 1:110 HICKORY ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1724
Mailing Address - Country:US
Mailing Address - Phone:541-981-2837
Mailing Address - Fax:541-704-0721
Practice Address - Street 1:700 BELLEVUE ST SE
Practice Address - Street 2:STE 120
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3819
Practice Address - Country:US
Practice Address - Phone:503-485-2552
Practice Address - Fax:503-485-2245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR356726-90332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274330Medicaid
OR274330Medicaid