Provider Demographics
NPI:1437155934
Name:SLEEPWELL PARTNER LLC
Entity Type:Organization
Organization Name:SLEEPWELL PARTNER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ COO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GREISL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-706-1080
Mailing Address - Street 1:615 W CARMEL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5504
Mailing Address - Country:US
Mailing Address - Phone:317-706-1080
Mailing Address - Fax:317-706-1022
Practice Address - Street 1:12901 SE 97TH AVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-7901
Practice Address - Country:US
Practice Address - Phone:503-652-0067
Practice Address - Fax:503-652-0068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVASTRA USA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-21
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR247423Medicaid
OR820243000OtherBLUESHIELD
OR820243000OtherBLUESHIELD
OR137831Medicare PIN