Sleep Disorder Center of Eastern Idaho, Inc.

Primary specialty

Sleep Disorder Diagnostic Clinic/CenterTaxonomy code 261QS1200X

Legal business name

SLEEP DISORDER CENTER OF EASTERN IDAHO, INC.

Practice address

2001 S Woodruff
Ste 11
Idaho Falls, ID 83404

Phone

(208) 524-8044

Fax

(208) 525-8896

NPI assigned

Jan 18, 2007

Last updated

Dec 18, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sandra M Jackson, POLYSOMNOGRAPHIST

Title

Owner

Phone

(208) 524-8044

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229558400000",
    "number": "1427100270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF",
            "address_2": "STE 11",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-524-8044",
            "fax_number": "208-525-8896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF",
            "address_2": "STE 11",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-524-8044",
            "fax_number": "208-525-8896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SLEEP DISORDER CENTER OF EASTERN IDAHO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2008-12-18",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-524-8044",
        "authorized_official_credential": "POLYSOMNOGRAPHIST"
    },
    "taxonomies": [
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8A646",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010001762",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805240900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erinn Michelle Skidmore, BA
• Cindy Ann Skinner, RN
• Jeanette Moss Slater, FNP-C
• Sleep Better Idaho Falls LLC
• Sleep Directions LLC
• Jerry B Smedley, D.O.
• Allison Rae Smith-Varela, RBT
• Amanda Rae Smith
• Benjamin Smith, DO
• Brad D Smith, D.O.

• Sleep Disorder Diagnostic Clinic/Center in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Sleep Disorder Diagnostic Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.