1174620710 NPI number — SUPERIAIRE OXYGEN & EQUIPMENT, INC.

Table of content: (NPI 1174620710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174620710 NPI number — SUPERIAIRE OXYGEN & EQUIPMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPERIAIRE OXYGEN & 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:
SHORELINE MEDICAL SOLUTIONS
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:
1174620710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 W OAK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PANAMA CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32401-2737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-769-0080
Provider Business Mailing Address Fax Number:
850-785-3661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 W OAK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANAMA CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32401-2737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-769-0080
Provider Business Practice Location Address Fax Number:
850-785-3661
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TRONG
Authorized Official First Name:
DENYSE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT/ OWNER
Authorized Official Telephone Number:
850-769-0080

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  1973 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 025923300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: R9379 . This is a "B/C B/S PROVIDER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 108921800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com