1083684690 NPI number — MEDIC-AIRE MEDICAL EQUIPMENT INC

Table of content: (NPI 1083684690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083684690 NPI number — MEDIC-AIRE MEDICAL EQUIPMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDIC-AIRE MEDICAL EQUIPMENT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDIC-AIRE MEDICAL EQUIPMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083684690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27968
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84127-0968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-966-8030
Provider Business Mailing Address Fax Number:
570-966-8040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 PRINCE FREDERICK BLVD
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
PRINCE FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20678-3922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-535-5039
Provider Business Practice Location Address Fax Number:
410-535-5094
Provider Enumeration Date:
01/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MENCHEN
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
407-822-4600

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 652800700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".