Provider Demographics
NPI:1194771402
Name:NORTH PUGET SOUND CENTER FOR SLEEP DISORDERS
Entity type:Organization
Organization Name:NORTH PUGET SOUND CENTER FOR SLEEP DISORDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GREENSHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:425-740-4176
Mailing Address - Street 1:1728 W MARINE VIEW DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2094
Mailing Address - Country:US
Mailing Address - Phone:425-740-4176
Mailing Address - Fax:425-252-6642
Practice Address - Street 1:1728 W MARINE VIEW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2094
Practice Address - Country:US
Practice Address - Phone:425-740-4176
Practice Address - Fax:425-252-6642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8809267Medicare PIN