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General NPI Number Information
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NPI Number | 1225314024
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Entity Type | Organization
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Legal Business Name | 2ND WIND SLEEP MEDICAL EQUIPMENT, LLC
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 9900 SW GREENBURG RD SUITE 275
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City | TIGARD
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State | OR
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Zip | 97223-5502
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Country | US
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Telephone | 503-747-6857
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Fax | 541-747-6891
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Provider Business Mailing Address
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Address Line | 110 HICKORY ST NW
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City | ALBANY
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State | OR
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Zip | 97321-1724
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Country | US
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Telephone | 541-981-2837
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Fax | 541-704-0721
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Authorized Official
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Title or Position | CEO-CO
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Name | MR. KEVIN JAMES PATRICK
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Credential |
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Telephone | 541-981-2837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 356726-90
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License Number State | OR
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