Organization
SOUND SLEEP CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KELLY D JOHNSON (EXECUTIVE DIRECTOR)
(763) 315-4300
Entity
Organization
Contact information
Practice address
12000 ELM CREEK BLVD N, SUITE 360, MAPLE GROVE, MN 55369-7073
(763) 315-4300
(763) 315-4360
Mailing address
12000 ELM CREEK BLVD N, SUITE 360, MAPLE GROVE, MN 55369-7073
(763) 315-4300
(763) 315-4360
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
6586527
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6774633
CIGNA
MN
01
—
68G29S0
BLUE CROSS BLUE SHIELD MN
MN
01
—
94524
HEALTHPARTNERS
MN
Enumeration date
11/27/2006
Last updated
08/22/2020
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