Provider Demographics
NPI:1053587006
Name:COLUMBIA SLEEP SERVICES
Entity type:Organization
Organization Name:COLUMBIA SLEEP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KENEMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-810-6687
Mailing Address - Street 1:PO BOX 16907
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0907
Mailing Address - Country:US
Mailing Address - Phone:503-257-5955
Mailing Address - Fax:
Practice Address - Street 1:10735 SE STARK ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2765
Practice Address - Country:US
Practice Address - Phone:503-257-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1200X
OR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6267800001Medicare NSC