Provider Demographics
NPI:1740503358
Name:CENTER FOR SLEEP LLC
Entity type:Organization
Organization Name:CENTER FOR SLEEP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOSLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-356-3000
Mailing Address - Street 1:4152 30TH AVE S
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8403
Mailing Address - Country:US
Mailing Address - Phone:701-356-3000
Mailing Address - Fax:701-271-9260
Practice Address - Street 1:4152 30TH AVE S
Practice Address - Street 2:SUITE 103B
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8403
Practice Address - Country:US
Practice Address - Phone:701-356-3000
Practice Address - Fax:701-271-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10030207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15430Medicaid
MN1740503358Medicaid
ND15430Medicaid