Provider Demographics
NPI:1124346853
Name:2ND WIND SLEEP MEDICAL EQUIPMENT, LLC
Entity type:Organization
Organization Name:2ND WIND SLEEP MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:503-485-2552
Mailing Address - Street 1:229 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2815
Mailing Address - Country:US
Mailing Address - Phone:541-981-2837
Mailing Address - Fax:541-704-0521
Practice Address - Street 1:2296 NW KINGS BLVD
Practice Address - Street 2:STE. 101
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3899
Practice Address - Country:US
Practice Address - Phone:541-368-5008
Practice Address - Fax:541-368-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5869380003Medicare NSC