Healthcare Provider Details

I. General information

NPI: 1437155934
Provider Name (Legal Business Name): SLEEPWELL PARTNER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 SE 97TH AVE
CLACKAMAS OR
97015-7901
US

IV. Provider business mailing address

615 W CARMEL DR SUITE 100
CARMEL IN
46032-5504
US

V. Phone/Fax

Practice location:
  • Phone: 503-652-0067
  • Fax: 503-652-0068
Mailing address:
  • Phone: 317-706-1080
  • Fax: 317-706-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier247423
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier820243000
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerBLUESHIELD

VIII. Authorized Official

Name: MR. KEITH GREISL
Title or Position: PRESIDENT/ COO
Credential:
Phone: 317-706-1080