Provider Demographics
NPI:1942695770
Name:10TH PLANET LLC
Entity Type:Organization
Organization Name:10TH PLANET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:GEMMILL
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:215-262-4718
Mailing Address - Street 1:2125 SE OAK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1606
Mailing Address - Country:US
Mailing Address - Phone:215-262-4718
Mailing Address - Fax:
Practice Address - Street 1:2125 SE OAK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1606
Practice Address - Country:US
Practice Address - Phone:215-262-4718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty