Provider Demographics
NPI:1467718064
Name:SLEEP CENTER OF WILLMAR, LLC
Entity Type:Organization
Organization Name:SLEEP CENTER OF WILLMAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JARAD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:RIPPERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-441-2104
Mailing Address - Street 1:2100 19TH AVE SW STE 1
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-5287
Mailing Address - Country:US
Mailing Address - Phone:320-441-2104
Mailing Address - Fax:320-441-2052
Practice Address - Street 1:2100 19TH AVE SW STE 1
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-5287
Practice Address - Country:US
Practice Address - Phone:320-441-2104
Practice Address - Fax:320-441-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6586527261QS1200X
MN261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6586527OtherMN LICENSE