Basic Information
| Provider Information | |||||||||
| NPI: | 1124315700 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHSTAR SLEEP CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 E 28TH ST | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071139 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3800 COON RAPIDS BLVD NW | ||||||||
| Address2: | SUITE 3800 | ||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525677400 | ||||||||
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| ProviderEnumerationDate: | 07/05/2011 | ||||||||
| LastUpdateDate: | 08/06/2018 | ||||||||
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| AuthorizedOfficialLastName: | MAYER | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | JANE | ||||||||
| AuthorizedOfficialTitleorPosition: | B.O. MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5298525284 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.