Provider Demographics
NPI:1164656898
Name:VERLO MATTRESS FACTORY STORES APPLETON AND OSHKOSH
Entity Type:Organization
Organization Name:VERLO MATTRESS FACTORY STORES APPLETON AND OSHKOSH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-378-2471
Mailing Address - Street 1:PO BOX 7256
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-7070
Mailing Address - Country:US
Mailing Address - Phone:920-378-2471
Mailing Address - Fax:920-734-6077
Practice Address - Street 1:4884 W LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-9200
Practice Address - Country:US
Practice Address - Phone:920-378-2471
Practice Address - Fax:920-734-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-09
Last Update Date:2009-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIV018983332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies