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General NPI Number Information
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NPI Number | 1154639573
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Entity Type | Organization
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Legal Business Name | MAPLE LEAF MEDICAL SERVICES, LLC
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 127A S STATE ST
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City | GENESEO
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State | IL
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Zip | 61254-1361
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Country | US
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Telephone | 309-944-1190
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Fax | 309-944-1390
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Provider Business Mailing Address
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Address Line | 127A S STATE ST
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City | GENESEO
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State | IL
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Zip | 61254-1347
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Country | US
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Telephone | 309-944-1190
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Fax | 309-944-1390
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Authorized Official
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Title or Position | OWNER
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Name | MRS. HEATHER DEBROCK
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Credential |
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Telephone | 309-944-1190
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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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