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General NPI Number Information
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NPI Number | 1033907522
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Entity Type | Organization
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Legal Business Name | OSCEOLA SLEEP CENTER LLC
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 2600 65TH AVE
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City | OSCEOLA
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State | WI
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Zip | 54020-4376
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Country | US
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Telephone | 715-294-4755
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Fax | 715-294-4736
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Provider Business Mailing Address
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Address Line | 10600 OLD COUNTY ROAD 15 STE 140
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City | PLYMOUTH
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State | MN
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Zip | 55441-6201
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Country | US
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Telephone | 952-737-0533
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Fax |
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Authorized Official
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Title or Position | CEO & PRESIDENT, OPERATING MEMBER
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Name | GEORGE OMAE
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Credential |
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Telephone | 952-737-0533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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