Provider Demographics
NPI:1912143736
Name:MOUNTAIN SLEEP LAB LLC
Entity Type:Organization
Organization Name:MOUNTAIN SLEEP LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:DESCHWEINITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-890-4462
Mailing Address - Street 1:1609 E BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8284
Mailing Address - Country:US
Mailing Address - Phone:541-245-9666
Mailing Address - Fax:
Practice Address - Street 1:1609 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8284
Practice Address - Country:US
Practice Address - Phone:541-245-9666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200932934291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory