Provider Demographics
NPI:1528060159
Name:AIRWAY RESPIRATORY SOLUTIONS, LLC
Entity type:Organization
Organization Name:AIRWAY RESPIRATORY SOLUTIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-343-3006
Mailing Address - Street 1:905 E ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-3401
Mailing Address - Country:US
Mailing Address - Phone:352-343-3006
Mailing Address - Fax:352-343-9006
Practice Address - Street 1:905 E ALFRED ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3401
Practice Address - Country:US
Practice Address - Phone:352-343-3006
Practice Address - Fax:352-343-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313037332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031601600Medicaid
FL031601600Medicaid