Healthcare Provider Details

I. General information

NPI: 1033907522
Provider Name (Legal Business Name): OSCEOLA SLEEP CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 65TH AVE
OSCEOLA WI
54020-4376
US

IV. Provider business mailing address

10600 OLD COUNTY ROAD 15 STE 140
PLYMOUTH MN
55441-6201
US

V. Phone/Fax

Practice location:
  • Phone: 715-294-4755
  • Fax: 715-294-4736
Mailing address:
  • Phone: 952-737-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GEORGE OMAE
Title or Position: CEO & PRESIDENT, OPERATING MEMBER
Credential:
Phone: 952-737-0533