Healthcare Provider Details

I. General information

NPI: 1235501545
Provider Name (Legal Business Name): SLEEP CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N OREM BLVD SUITE 417
OREM UT
84057
US

IV. Provider business mailing address

417 N OREM BLVD SUITE 417
OREM UT
84057-8813
US

V. Phone/Fax

Practice location:
  • Phone: 801-691-1556
  • Fax:
Mailing address:
  • Phone: 801-691-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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:

VIII. Authorized Official

Name: DR. PETER DITTMER
Title or Position: MANAGING PARTNER
Credential: ED.D
Phone: 801-691-1556