Provider Demographics
NPI:1689985335
Name:HERMISTON SLEEP LAB LLC
Entity Type:Organization
Organization Name:HERMISTON SLEEP LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAMNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:509-946-4631
Mailing Address - Street 1:800 SWIFT BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3549
Mailing Address - Country:US
Mailing Address - Phone:509-946-4631
Mailing Address - Fax:509-943-6065
Practice Address - Street 1:610 NW 11TH ST
Practice Address - Street 2:C-111
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-6601
Practice Address - Country:US
Practice Address - Phone:509-946-4631
Practice Address - Fax:509-943-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16522261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic