Provider Demographics
NPI:1235501545
Name:SLEEP CLINIC
Entity Type:Organization
Organization Name:SLEEP CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DITTMER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:801-691-1556
Mailing Address - Street 1:417 N OREM BLVD
Mailing Address - Street 2:SUITE 417
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-8813
Mailing Address - Country:US
Mailing Address - Phone:801-691-1556
Mailing Address - Fax:
Practice Address - Street 1:417 N OREM BLVD
Practice Address - Street 2:SUITE 417
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057
Practice Address - Country:US
Practice Address - Phone:801-691-1556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic