Provider Demographics
NPI:1801846662
Name:WHITNEY SLEEP ASSOCIATES LLC
Entity Type:Organization
Organization Name:WHITNEY SLEEP ASSOCIATES LLC
Other - Org Name:WHITNEY SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:763-519-0634
Mailing Address - Street 1:2700 CAMPUS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2601
Mailing Address - Country:US
Mailing Address - Phone:763-519-0634
Mailing Address - Fax:763-519-0636
Practice Address - Street 1:2700 CAMPUS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2601
Practice Address - Country:US
Practice Address - Phone:763-519-0634
Practice Address - Fax:763-519-0636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39456261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN376913000Medicaid
MNC03375Medicare PIN