# CREEKSIDE SLEEP MEDICINE CENTER PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184841256
- **Authorized official:** MRS. TERESA E. JACOBS M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (425) 278-2250

## Contact information

- **Practice address:** 1380 112TH AVE NE, \#307, BELLEVUE, WA 98004-3759
- **Practice address phone:** (425) 278-2250
- **Practice address fax:** (425) 562-5885
- **Mailing address:** 1380 112TH AVE NE, \#307, BELLEVUE, WA 98004-3759
- **Mailing address phone:** (425) 278-2250
- **Mailing address fax:** (425) 562-5885

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS1201X | Sleep Medicine (Family Medicine) Physician | — | WA | Yes |
| 261QS1200X | Sleep Disorder Diagnostic Clinic/Center | 602620178 | WA | — |

## Other

- **Enumeration date:** 04/19/2007
- **Last updated:** 12/13/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 602620178 | UBI | WA |