Provider Demographics
NPI:1780735993
Name:CENTRAL MINNESOTA SLEEP SPECIALISTS, PLC
Entity type:Organization
Organization Name:CENTRAL MINNESOTA SLEEP SPECIALISTS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER AND CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GREATENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-963-7302
Mailing Address - Street 1:PO BOX 750
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-0750
Mailing Address - Country:US
Mailing Address - Phone:218-963-7302
Mailing Address - Fax:218-961-0880
Practice Address - Street 1:523 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3054
Practice Address - Country:US
Practice Address - Phone:218-828-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35397207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04518Medicare PIN
MNF29006Medicare UPIN