Provider Demographics
NPI:1619355831
Name:DOUGLAS MEDICAL EQUIPMENT SUPPLY
Entity Type:Organization
Organization Name:DOUGLAS MEDICAL EQUIPMENT SUPPLY
Other - Org Name:DBA PACIFIC SLEEP LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ABCT COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:E
Authorized Official - Last Name:TORVIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-464-4492
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:DOUGLAS MEDICAL EQUIPMENT SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-07
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR500643-94261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic