| Koala Center For Sleep Disorders | |
|
413 N 17th Ave Ste 100 Wausau WI 54401-4287 | |
| (715) 218-4900 | |
| (715) 355-5790 |
| Full Name | Koala Center For Sleep Disorders |
|---|---|
| Speciality | Durable Medical Equipment & Medical Supplies |
| Location | 413 N 17th Ave Ste 100, Wausau, Wisconsin |
| Authorized Official Name and Position | Rodney Earl Willey (OWNER) |
| Authorized Official Contact | 3093768385 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Koala Center For Sleep Disorders 305 S 18th Ave Suite 300 Wausau WI 54401-4208 Ph: (715) 218-4900 | Koala Center For Sleep Disorders 413 N 17th Ave Ste 100 Wausau WI 54401-4287 Ph: (715) 218-4900 |
| NPI Number | 1114342847 |
|---|---|
| Provider Enumeration Date | 03/05/2014 |
| Last Update Date | 09/10/2020 |
| Medicare PECOS PAC ID | 0042436438 |
|---|---|
| Medicare Enrollment ID | O20140721001049 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114342847 | NPI | - | NPPES |
| 7230170001 | Other | MEDICARE DME |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3272 (Wisconsin) | Secondary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Primary |
| Provider Name | Jackie Marie Rietz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326691254 PECOS PAC ID: 1254661747 Enrollment ID: I20190926000372 |
| Provider Name | Brian L Sorensen |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1194212639 PECOS PAC ID: 1951632983 Enrollment ID: I20191007000531 |
| Provider Name | Rodney Earl Willey |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1144409806 PECOS PAC ID: 4688746159 Enrollment ID: I20210318000112 |
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