Provider Demographics
NPI:1134313208
Name:SLEEP CENTER OF CENTRAL MINNESOTA LLC
Entity Type:Organization
Organization Name:SLEEP CENTER OF CENTRAL MINNESOTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-546-4366
Mailing Address - Street 1:13495 ELDER DR STE 120
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8764
Mailing Address - Country:US
Mailing Address - Phone:218-454-0225
Mailing Address - Fax:
Practice Address - Street 1:13495 ELDER DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425
Practice Address - Country:US
Practice Address - Phone:612-790-8762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5996470001Medicare NSC