Healthcare Provider Details

I. General information

NPI: 1124080783
Provider Name (Legal Business Name): EMERALD SLEEP DISORDERS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 VILLAGE PLAZA LOOP SUITE 101
EUGENE OR
97401-6677
US

IV. Provider business mailing address

4725 VILLAGE PLAZA LOOP SUITE 101
EUGENE OR
97401-6677
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-3325
  • Fax: 541-343-4117
Mailing address:
  • Phone: 541-683-3325
  • Fax: 541-343-4117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOR

VIII. Authorized Official

Name: DR. ROBERT GEORGE TEARSE
Title or Position: MEDICAL DIRECTOT
Credential: M.D.
Phone: 541-683-3325