Provider Demographics
NPI:1114342847
Name:SLEEP APNEA CARE AND WELLNESS LLC
Entity Type:Organization
Organization Name:SLEEP APNEA CARE AND WELLNESS LLC
Other - Org Name:KOALA CENTER FOR SLEEP DISORDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-376-8385
Mailing Address - Street 1:305 S 18TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4208
Mailing Address - Country:US
Mailing Address - Phone:715-218-4900
Mailing Address - Fax:715-355-5790
Practice Address - Street 1:413 N 17TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4287
Practice Address - Country:US
Practice Address - Phone:715-218-4900
Practice Address - Fax:715-355-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3272122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7230170001OtherMEDICARE DME