Organization
IDAHO DIAGNOSTIC SLEEP LAB, INC.
Active
Other names
Western Sleep Disorders Center
Organization subpart
No
Provider details
NPI number
Authorized official
SEAN D CHRISTENSEN (PRESIDENT)
(208) 736-7646
Entity
Organization
Contact information
Practice address
2423 S GEORGIA AVE, CALDWELL, ID 83605-4477
(208) 736-7646
(208) 736-1569
Mailing address
526 SHOUP AVE W STE C, TWIN FALLS, ID 83301-5050
(208) 736-7646
(208) 736-1569
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149908
BLUE SHIELD OF IDAHO
ID
05
—
232489
—
OR
01
—
8L378
BLUE CROSS OF IDAHO
ID
Enumeration date
01/25/2007
Last updated
08/22/2020
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