Provider Demographics
NPI:1740238427
Name:DELTA WAVES, INC.
Entity Type:Organization
Organization Name:DELTA WAVES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-262-9283
Mailing Address - Street 1:5835 LEHMAN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3408
Mailing Address - Country:US
Mailing Address - Phone:719-262-9283
Mailing Address - Fax:719-262-9285
Practice Address - Street 1:5835 LEHMAN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3408
Practice Address - Country:US
Practice Address - Phone:719-262-9283
Practice Address - Fax:719-262-9285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 332B00000X
CO20051285117261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO805010Medicare ID - Type UnspecifiedBILLING NUMBER