Provider Demographics
NPI:1700642683
Name:SLEEP WAKE IDAHO PLLC
Entity Type:Organization
Organization Name:SLEEP WAKE IDAHO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RASMUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-884-2922
Mailing Address - Street 1:7272 W POTOMAC DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9149
Mailing Address - Country:US
Mailing Address - Phone:208-884-2922
Mailing Address - Fax:
Practice Address - Street 1:7272 W POTOMAC DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9149
Practice Address - Country:US
Practice Address - Phone:208-884-2922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty