Provider Demographics
NPI:1306866231
Name:DALEY'S MEDICAL AND RENTAL SUPPLY
Entity Type:Organization
Organization Name:DALEY'S MEDICAL AND RENTAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WAPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-841-8090
Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-0659
Mailing Address - Country:US
Mailing Address - Phone:708-841-8090
Mailing Address - Fax:708-849-0997
Practice Address - Street 1:1234 E SIBLEY BLVD
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-2944
Practice Address - Country:US
Practice Address - Phone:708-841-8090
Practice Address - Fax:708-849-0997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000559332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========OtherBLUE CROSS BLUE SHIELD IL
IL=========OtherBLUE CROSS BLUE SHIELD IL