Provider Demographics
NPI:1881979722
Name:SIDESTIX VENTURES USA
Entity type:Organization
Organization Name:SIDESTIX VENTURES USA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:877-464-7849
Mailing Address - Street 1:245 4TH ST
Mailing Address - Street 2:STE 204
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-5698
Mailing Address - Country:US
Mailing Address - Phone:877-464-7849
Mailing Address - Fax:
Practice Address - Street 1:410 IDA ST. WEST
Practice Address - Street 2:STE 201
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337
Practice Address - Country:US
Practice Address - Phone:877-464-7849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603 138 435332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies