Provider Demographics
NPI:1497787253
Name:SLEEPWELL LABORATORIES, INC.
Entity Type:Organization
Organization Name:SLEEPWELL LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:503-652-0067
Mailing Address - Street 1:9717 SE SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9784
Mailing Address - Country:US
Mailing Address - Phone:503-652-0067
Mailing Address - Fax:503-652-0068
Practice Address - Street 1:9717 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9784
Practice Address - Country:US
Practice Address - Phone:503-652-0067
Practice Address - Fax:503-652-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275323Medicaid
OR275323Medicaid