Provider Demographics
NPI:1942445523
Name:PACIFIC NORTHWEST SLEEP CENTERS, LLC
Entity type:Organization
Organization Name:PACIFIC NORTHWEST SLEEP CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:O'KEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:5035-540-4052
Mailing Address - Street 1:702 CHURCH ST NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2404
Mailing Address - Country:US
Mailing Address - Phone:503-540-4052
Mailing Address - Fax:503-540-4054
Practice Address - Street 1:702 CHURCH ST NE
Practice Address - Street 2:SUITE B
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2404
Practice Address - Country:US
Practice Address - Phone:503-540-4052
Practice Address - Fax:503-540-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500605759Medicaid
OR500605759Medicaid