Organization Name: | PACIFIC SLEEP & RESPIRATORY DIAGNOSTICS, LLC |
NPI Number: | 1083991772 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DARREL MARTIN WOODRUFF (MEMBER MANAGER) |
Mailing Address: | 21 N Adams St Coquille |
State: | OR US |
Postal Code: | 974231858 |
Phone Number: | 5419824156 |
Fax Number: | 5417569015 |
NPI Enumeration Date: | 11/08/2011 |
NPI Last Update Date: | 08/10/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QS1200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Sleep Disorder Diagnostic |
Taxonomy Definition: |