Provider Demographics
NPI:1639441165
Name:CENTRAL WASHINGTON SLEEP DIAGNOSTIC CENTER, PLLC
Entity type:Organization
Organization Name:CENTRAL WASHINGTON SLEEP DIAGNOSTIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-449-0619
Mailing Address - Street 1:PO BOX 1092
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812-1092
Mailing Address - Country:US
Mailing Address - Phone:509-689-6666
Mailing Address - Fax:509-689-2330
Practice Address - Street 1:520 W INDIAN AVENUE
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812
Practice Address - Country:US
Practice Address - Phone:509-689-0100
Practice Address - Fax:509-689-0596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty