Healthcare Provider Details

I. General information

NPI: 1740238427
Provider Name (Legal Business Name): DELTA WAVES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 LEHMAN DR SUITE 101
COLORADO SPRINGS CO
80918-3408
US

IV. Provider business mailing address

5835 LEHMAN DR SUITE 101
COLORADO SPRINGS CO
80918-3408
US

V. Phone/Fax

Practice location:
  • Phone: 719-262-9283
  • Fax: 719-262-9285
Mailing address:
  • Phone: 719-262-9283
  • Fax: 719-262-9285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number20051285117
License Number StateCO

VIII. Authorized Official

Name: DALE MOSELEY
Title or Position: VICE PRESIDENT
Credential:
Phone: 719-262-9283