Healthcare Provider Details

I. General information

NPI: 1285641423
Provider Name (Legal Business Name): LOLED ACOUSTIC TOURS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 S MAIN ST
ZUMBROTA MN
55992-1544
US

IV. Provider business mailing address

370 S MAIN ST
ZUMBROTA MN
55992-1544
US

V. Phone/Fax

Practice location:
  • Phone: 507-732-5311
  • Fax:
Mailing address:
  • Phone: 507-732-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MICHAEL S BRENGMAN
Title or Position: PRESIDENT
Credential: R.PH
Phone: 507-732-5311