Healthcare Provider Details

I. General information

NPI: 1629265798
Provider Name (Legal Business Name): CENTRAL WASHINGTON SLEEP DIAGNOSTIC CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N MISSION ST
WENATCHEE WA
98801-2049
US

IV. Provider business mailing address

PO BOX 1092
BREWSTER WA
98812-1092
US

V. Phone/Fax

Practice location:
  • Phone: 509-663-1578
  • Fax: 509-663-0174
Mailing address:
  • Phone: 509-663-1578
  • Fax: 509-663-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC E. HAEGER
Title or Position: CEO
Credential: M.D.
Phone: 509-449-0619