Healthcare Provider Details

I. General information

NPI: 1942445523
Provider Name (Legal Business Name): PACIFIC NORTHWEST SLEEP CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 CHURCH ST NE SUITE B
SALEM OR
97301-2404
US

IV. Provider business mailing address

702 CHURCH ST NE SUITE B
SALEM OR
97301-2404
US

V. Phone/Fax

Practice location:
  • Phone: 503-540-4052
  • Fax: 503-540-4054
Mailing address:
  • Phone: 503-540-4052
  • Fax: 503-540-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES O'KEEFE
Title or Position: CHIEF OPERATING OFFICER
Credential: BA
Phone: 50355404052