Provider Demographics
NPI:1689889735
Name:PACIFIC SLEEP MEDICINE SERVICES, INC
Entity Type:Organization
Organization Name:PACIFIC SLEEP MEDICINE SERVICES, INC
Other - Org Name:CARDIOSOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-706-1080
Mailing Address - Street 1:615 W CARMEL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5504
Mailing Address - Country:US
Mailing Address - Phone:317-706-1080
Mailing Address - Fax:317-706-1080
Practice Address - Street 1:2420 VISTA WAY
Practice Address - Street 2:SUITE 115
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6190
Practice Address - Country:US
Practice Address - Phone:760-721-7594
Practice Address - Fax:760-721-9201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DORMIR, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-11
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52918332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1217200004Medicare NSC