Provider Demographics
NPI:1932354701
Name:WHITNEY SLEEP DIAGNOSTICS & CONSULTANTS, LLC
Entity Type:Organization
Organization Name:WHITNEY SLEEP DIAGNOSTICS & CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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 1:119 GRAYSTONE PLZ
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3034
Mailing Address - Country:US
Mailing Address - Phone:218-844-6150
Mailing Address - Fax:763-201-5545
Practice Address - Street 1:714 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3012
Practice Address - Country:US
Practice Address - Phone:218-844-6150
Practice Address - Fax:763-201-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1932354701Medicaid
MN6342400001Medicare NSC