Provider Demographics
NPI:1629321435
Name:SOUTHERN OREGON SLEEP DIAGNOSTICS
Entity Type:Organization
Organization Name:SOUTHERN OREGON SLEEP DIAGNOSTICS
Other - Org Name:MOUNTAIN SLEEP LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-773-1435
Mailing Address - Street 1:460 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8144
Mailing Address - Country:US
Mailing Address - Phone:541-773-1435
Mailing Address - Fax:541-858-6828
Practice Address - Street 1:460 MURPHY RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8144
Practice Address - Country:US
Practice Address - Phone:541-773-1435
Practice Address - Fax:541-858-6828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic