Provider Demographics
NPI:1922330109
Name:OREGON SLEEP SPECIALIST SERVICES
Entity Type:Organization
Organization Name:OREGON SLEEP SPECIALIST SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-786-2955
Mailing Address - Street 1:700 SUNSET DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1260
Mailing Address - Country:US
Mailing Address - Phone:866-285-4245
Mailing Address - Fax:866-396-7655
Practice Address - Street 1:700 SUNSET DR
Practice Address - Street 2:SUITE B
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1260
Practice Address - Country:US
Practice Address - Phone:866-285-4245
Practice Address - Fax:866-396-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies