| Koala Center For Sleep Disorders In-2 | |
|
4921 Sr 26 E Suite 300 Lafayette IN 47905 | |
| (309) 243-8980 | |
| Not Available |
| Full Name | Koala Center For Sleep Disorders In-2 |
|---|---|
| Speciality | Dentist |
| Location | 4921 Sr 26 E, Lafayette, Indiana |
| Authorized Official Name and Position | Shane Cope (OWNER) |
| Authorized Official Contact | 3176407907 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Koala Center For Sleep Disorders In-2 4921 Sr 26 E Suite 300 Lafayette IN 47905 Ph: () - | Koala Center For Sleep Disorders In-2 4921 Sr 26 E Suite 300 Lafayette IN 47905 Ph: (309) 243-8980 |
| NPI Number | 1134596869 |
|---|---|
| Provider Enumeration Date | 08/28/2015 |
| Last Update Date | 05/16/2016 |
| Medicare PECOS PAC ID | 9537460944 |
|---|---|
| Medicare Enrollment ID | O20151208003105 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134596869 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12011052A (Indiana) | Primary |
| Provider Name | Shane T Cope |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1386830503 PECOS PAC ID: 9537460852 Enrollment ID: I20151210001704 |
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