Provider Demographics
NPI:1285012963
Name:VANCOUVER SLEEP CENTER, LLC
Entity Type:Organization
Organization Name:VANCOUVER SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AKHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGHURAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-839-4532
Mailing Address - Street 1:16219 SE 12TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8904
Mailing Address - Country:US
Mailing Address - Phone:360-839-4532
Mailing Address - Fax:
Practice Address - Street 1:16219 SE 12TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-8904
Practice Address - Country:US
Practice Address - Phone:360-839-4532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045684207RS0012X
ORMD28263207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA603 492 359OtherBUSINESS LICENSE