Provider Demographics
NPI:1790094530
Name:MATTRESS GALLERY
Entity Type:Organization
Organization Name:MATTRESS GALLERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-554-7242
Mailing Address - Street 1:3125 LONE OAK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-5743
Mailing Address - Country:US
Mailing Address - Phone:270-554-7225
Mailing Address - Fax:270-554-7242
Practice Address - Street 1:3125 LONE OAK RD
Practice Address - Street 2:SUITE B
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-5743
Practice Address - Country:US
Practice Address - Phone:270-554-7225
Practice Address - Fax:270-554-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition