Provider Demographics
NPI:1760840755
Name:ATLAS SLEEP DIAGNOSTICS LLC
Entity type:Organization
Organization Name:ATLAS SLEEP DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:360-998-3232
Mailing Address - Street 1:3627 ENSIGN RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-6104
Mailing Address - Country:US
Mailing Address - Phone:360-998-3232
Mailing Address - Fax:360-998-3238
Practice Address - Street 1:3627 ENSIGN RD NE STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-6104
Practice Address - Country:US
Practice Address - Phone:360-998-3232
Practice Address - Fax:360-998-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603514766261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center