NPIMap

Organization Active NPI

Idaho Diagnostic Sleep Lab, Inc.

  • Sleep Disorder Diagnostic Clinic/Center
  • Twin Falls, ID
National Provider Identifier
1992850671
Registry record updated Jan 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Disorder Diagnostic Clinic/CenterTaxonomy code 261QS1200X
License
002743400 Issued in ID
Legal business name
IDAHO DIAGNOSTIC SLEEP LAB, INC.
Practice address
526 Shoup Ave W Ste C
Twin Falls, ID 83301-5050
Phone
(208) 736-7646
Fax
(208) 736-1569
NPI assigned
Jan 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Sean D Christensen
Title
President
Phone
(208) 736-7646

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Disorder Diagnostic Clinic/Center 261QS1200X 002743400 ID Primary

Addresses

Primary practice location

526 Shoup Ave W Ste C
Twin Falls, ID 83301-5050

Mailing address

526 Shoup Ave W Ste C
Twin Falls, ID 83301-5050
Phone (208) 736-7646

Other identifiers 4

IdentifierTypeStateIssuer
85563OtherIDBLUE CROSS OF IDAHO
002743400MedicaidID
P00091316OtherIDRAILROAD MEDICARE
000010000391OtherIDBLUE SHIELD OF IDAHO

National Provider Directory

National Provider Directory

Locations

526 Shoup Ave W
Ste C
Twin Falls, ID 83301
Phone (208) 736-7646

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326240000000",
    "number": "1992850671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 SHOUP AVE W STE C",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015050",
            "telephone_number": "208-736-7646",
            "fax_number": "208-736-1569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 SHOUP AVE W STE C",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015050",
            "telephone_number": "208-736-7646",
            "fax_number": "208-736-1569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DIAGNOSTIC SLEEP LAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2012-01-11",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "SEAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-736-7646",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": "ID",
            "license": "002743400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "85563",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002743400",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00091316",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF IDAHO",
            "identifier": "000010000391",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.