1972555787 NPI number — METROPOLITAN SLEEP DISORDERS CENTER, LLP

Table of content: (NPI 1972555787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972555787 NPI number — METROPOLITAN SLEEP DISORDERS CENTER, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN SLEEP DISORDERS CENTER, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1972555787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 SMITH AVE N
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55102-2572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-298-0350
Provider Business Mailing Address Fax Number:
651-298-0301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 SMITH AVE N
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102-2572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-298-0350
Provider Business Practice Location Address Fax Number:
651-298-0301
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LORENTZEN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
651-224-5895

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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