Provider Demographics
NPI:1326317355
Name:SLEEP MEDICINE GROUP LLC
Entity Type:Organization
Organization Name:SLEEP MEDICINE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-255-1200
Mailing Address - Street 1:10220 SW GREENBURG ROAD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5529
Mailing Address - Country:US
Mailing Address - Phone:503-255-1200
Mailing Address - Fax:503-408-6856
Practice Address - Street 1:10220 SW GREENBURG ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5529
Practice Address - Country:US
Practice Address - Phone:503-255-1200
Practice Address - Fax:503-408-6856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty