Basic Information
| Provider Information | |||||||||
| NPI: | 1912298290 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE WASHINGTON CENTER FOR PAIN MANAGEMENT SLEEP LAB | ||||||||
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| OtherOrganizationName: | WCPM SLEEP LAB | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21616 76TH AVE W | ||||||||
| Address2: | #102 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980267512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257741538 | ||||||||
| FaxNumber: | 4257441527 | ||||||||
| Practice Location | |||||||||
| Address1: | 21616 76TH AVE W | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980267512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257741538 | ||||||||
| FaxNumber: | 4257441527 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2011 | ||||||||
| LastUpdateDate: | 04/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | MENG | ||||||||
| AuthorizedOfficialFirstName: | LESLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING & COMPLIANCE LIAISON | ||||||||
| AuthorizedOfficialTelephone: | 4257741538 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.