Healthcare Provider Details

I. General information

NPI: 1841483880
Provider Name (Legal Business Name): EMERALD SLEEP DISORDERS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 08/23/2007
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 State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierR107232
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerLEGACY PROVIDER #

VIII. Authorized Official

Name: DR. ROBERT TEARSE
Title or Position: OWNER
Credential: MD
Phone: 541-683-3325