Provider Demographics
NPI:1760617211
Name:WELLMAN SLEEP SYSTEMS, LLC
Entity Type:Organization
Organization Name:WELLMAN SLEEP SYSTEMS, LLC
Other - Org Name:LAKESIDE DURABLE MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORTNIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RPSGT
Authorized Official - Phone:936-828-1919
Mailing Address - Street 1:123 BLUE HERON DR
Mailing Address - Street 2:STE 102
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-3192
Mailing Address - Country:US
Mailing Address - Phone:936-582-1112
Mailing Address - Fax:936-582-1151
Practice Address - Street 1:123 BLUE HERON DR
Practice Address - Street 2:STE 102
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-3192
Practice Address - Country:US
Practice Address - Phone:936-582-1112
Practice Address - Fax:936-582-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies