Organization
IDAHO DIAGNOSTIC SLEEP LAB, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SEAN D CHRISTENSEN (PRESIDENT)
(208) 736-7646
Entity
Organization
Contact information
Practice address
526 SHOUP AVE W STE C, TWIN FALLS, ID 83301-5050
(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
002743400
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010000391
BLUE SHIELD OF IDAHO
ID
05
—
002743400
—
ID
01
—
85563
BLUE CROSS OF IDAHO
ID
01
—
P00091316
RAILROAD MEDICARE
ID
Enumeration date
01/24/2007
Last updated
01/11/2012
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