Healthcare Provider Details

I. General information

NPI: 1306866231
Provider Name (Legal Business Name): DALEY'S MEDICAL AND RENTAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 E SIBLEY BLVD
DOLTON IL
60419-2944
US

IV. Provider business mailing address

PO BOX 659
DOLTON IL
60419-0659
US

V. Phone/Fax

Practice location:
  • Phone: 708-841-8090
  • Fax: 708-849-0997
Mailing address:
  • Phone: 708-841-8090
  • Fax: 708-849-0997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number203000559
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number203000559
License Number StateIL

VIII. Authorized Official

Name: MR. THOMAS WAPPEL
Title or Position: OWNER
Credential:
Phone: 708-841-8090