Provider Demographics
NPI:1104069319
Name:WESTSIDE SLEEP CENTER, LLC
Entity type:Organization
Organization Name:WESTSIDE SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:FROMHERZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-639-7000
Mailing Address - Street 1:7450 SW BEVELAND ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-639-7000
Mailing Address - Fax:503-639-7006
Practice Address - Street 1:7450 SW BEVELAND ST
Practice Address - Street 2:SUITE 120
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:503-639-7000
Practice Address - Fax:503-639-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD260062084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR133625Medicare PIN