Provider Demographics
NPI:1366091423
Name:REPOSE SLEEP MEDICINE, LLC
Entity type:Organization
Organization Name:REPOSE SLEEP MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:METELITS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-666-1177
Mailing Address - Street 1:6501 E GREENWAY PKWY STE 103-562
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2025
Mailing Address - Country:US
Mailing Address - Phone:602-666-1717
Mailing Address - Fax:602-666-1451
Practice Address - Street 1:6245 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-1706
Practice Address - Country:US
Practice Address - Phone:602-666-1717
Practice Address - Fax:602-666-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ13427OtherARIZONA STATE LICENSE