Provider Demographics
NPI:1124541776
Name:ACCESS SLEEP MD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ACCESS SLEEP MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-384-2135
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-0965
Mailing Address - Country:US
Mailing Address - Phone:503-384-2135
Mailing Address - Fax:503-914-1727
Practice Address - Street 1:9900 SW WILSHIRE ST STE 120
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5065
Practice Address - Country:US
Practice Address - Phone:503-384-2135
Practice Address - Fax:503-914-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0343275OtherAVAILITY CUSTOMER ID