Provider Demographics
NPI:1124080783
Name:EMERALD SLEEP DISORDERS CENTER, LLC
Entity type:Organization
Organization Name:EMERALD SLEEP DISORDERS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:TEARSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-683-3325
Mailing Address - Street 1:4725 VILLAGE PLAZA LOOP
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6677
Mailing Address - Country:US
Mailing Address - Phone:541-683-3325
Mailing Address - Fax:541-343-4117
Practice Address - Street 1:4725 VILLAGE PLAZA LOOP
Practice Address - Street 2:SUITE 101
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6677
Practice Address - Country:US
Practice Address - Phone:541-683-3325
Practice Address - Fax:541-343-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR332B00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR107232Medicare ID - Type Unspecified