| Whitney Sleep Diagnostics & Consultants, Llc | |
|
712 Washington Ave Detroit Lakes MN 56501-3012 | |
| (218) 844-6150 | |
| (763) 201-5545 |
| Full Name | Whitney Sleep Diagnostics & Consultants, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 712 Washington Ave, Detroit Lakes, Minnesota |
| Authorized Official Name and Position | Courtney Wade Whitney (PHYSICIAN/PRESIDENT) |
| Authorized Official Contact | 2188446150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Whitney Sleep Diagnostics & Consultants, Llc 119 Graystone Plz Suite 102 Detroit Lakes MN 56501-3034 Ph: (218) 844-6150 | Whitney Sleep Diagnostics & Consultants, Llc 712 Washington Ave Detroit Lakes MN 56501-3012 Ph: (218) 844-6150 |
| NPI Number | 1396985073 |
|---|---|
| Provider Enumeration Date | 02/20/2009 |
| Last Update Date | 02/21/2013 |
| Medicare PECOS PAC ID | 8022160431 |
|---|---|
| Medicare Enrollment ID | O20090716000111 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396985073 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 39456 (Minnesota) | Primary |
| Provider Name | Courtney W Whitney |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1861461329 PECOS PAC ID: 9739087826 Enrollment ID: I20031230000235 |
| Provider Name | Alfred Chiang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043243827 PECOS PAC ID: 8123194958 Enrollment ID: I20110323001033 |
| Provider Name | Adriana Andrea Escandon Sandino |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1942327689 PECOS PAC ID: 5092996686 Enrollment ID: I20170315000256 |
| Provider Name | Stephen Francis Derose |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1710272810 PECOS PAC ID: 1456583426 Enrollment ID: I20180321002453 |
| Provider Name | Idriz Kovacevic |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1861679706 PECOS PAC ID: 3476815606 Enrollment ID: I20180327002598 |
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