Healthcare Provider Details

I. General information

NPI: 1316188204
Provider Name (Legal Business Name): KOALA MATTRESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W FAIRFIELD DR
PENSACOLA FL
32505-4849
US

IV. Provider business mailing address

3800 W FAIRFIELD DR
PENSACOLA FL
32505-4849
US

V. Phone/Fax

Practice location:
  • Phone: 850-453-0000
  • Fax:
Mailing address:
  • Phone: 850-453-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberRS0700981
License Number StateFL

VIII. Authorized Official

Name: MRS. PENNY J LANG
Title or Position: PRESIDENT, CEO
Credential:
Phone: 850-453-0000