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General NPI Number Information
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NPI Number | 1457655698
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Entity Type | Organization
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Legal Business Name | DELTA SLEEP'S CPAP STORE
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 2416 E WASHINGTON ST STE. D4
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City | BLOOMINGTON
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State | IL
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Zip | 61704-4472
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Country | US
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Telephone | 309-663-2727
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Fax | 309-663-1818
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Provider Business Mailing Address
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Address Line | 2416 E WASHINGTON ST STE. D4
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City | BLOOMINGTON
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State | IL
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Zip | 61704-4472
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Country | US
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Telephone | 309-663-2727
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Fax | 309-663-1818
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. LAWRENCE JOSEPH LEHANE II
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Credential |
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Telephone | 309-663-2727
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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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