Organization
SLEEPWELL PARTNER LLC
Active
Parent organization
AVASTRA USA
Organization subpart
Yes
Provider details
NPI number
Legal business name
AVASTRA USA
Authorized official
MR. KEITH GREISL (PRESIDENT/ COO)
(317) 706-1080
Entity
Organization
Contact information
Practice address
12901 SE 97TH AVE, CLACKAMAS, OR 97015-7901
(503) 652-0067
(503) 652-0068
Mailing address
615 W CARMEL DR, SUITE 100, CARMEL, IN 46032-5504
(317) 706-1080
(317) 706-1022
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
247423
—
OR
01
—
820243000
BLUESHIELD
OR
Enumeration date
06/21/2005
Last updated
03/31/2010
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