| Koala Center For Sleep Disorders | |
|
2309 E Empire St Ste. 500 Bloomington IL 61704-8636 | |
| (309) 319-6568 | |
| (309) 664-0352 |
| Full Name | Koala Center For Sleep Disorders |
|---|---|
| Speciality | Dentist |
| Location | 2309 E Empire St, Bloomington, Illinois |
| Authorized Official Name and Position | James Todd Gray (OWNER/DENTIST) |
| Authorized Official Contact | 3093196568 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Koala Center For Sleep Disorders 2309 E Empire St Ste. 500 Bloomington IL 61704-8636 Ph: (309) 319-6568 | Koala Center For Sleep Disorders 2309 E Empire St Ste. 500 Bloomington IL 61704-8636 Ph: (309) 319-6568 |
| NPI Number | 1013280445 |
|---|---|
| Provider Enumeration Date | 02/15/2012 |
| Last Update Date | 04/27/2016 |
| Medicare PECOS PAC ID | 5092952010 |
|---|---|
| Medicare Enrollment ID | O20130513000079 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013280445 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019021753 (Illinois) | Primary |
| Provider Name | James T Gray |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1164659918 PECOS PAC ID: 8820237928 Enrollment ID: I20130621000261 |
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