Provider Demographics
NPI:1285641423
Name:LOLED ACOUSTIC TOURS, INC.
Entity type:Organization
Organization Name:LOLED ACOUSTIC TOURS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRENGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:507-732-5311
Mailing Address - Street 1:370 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ZUMBROTA
Mailing Address - State:MN
Mailing Address - Zip Code:55992-1544
Mailing Address - Country:US
Mailing Address - Phone:507-732-5311
Mailing Address - Fax:
Practice Address - Street 1:370 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ZUMBROTA
Practice Address - State:MN
Practice Address - Zip Code:55992-1544
Practice Address - Country:US
Practice Address - Phone:507-732-5311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN587760100Medicaid
0222100001Medicare ID - Type Unspecified