Provider Demographics
NPI:1326053794
Name:RICHLAND SLEEP LAB, INC
Entity Type:Organization
Organization Name:RICHLAND SLEEP LAB, INC
Other - Org Name:TRI-CITIES SLEEP DISORDERS CENTER & SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:POULIGNOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-946-4632
Mailing Address - Street 1:7233 W DESCHUTES AVE, SUITE A
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-946-4632
Mailing Address - Fax:509-943-9791
Practice Address - Street 1:7233 W DESCHUTES AVE, SUITE A
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-946-4632
Practice Address - Fax:509-943-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1065242Medicaid
WA6160960001Medicare NSC
WAG319203300Medicare PIN