1467603829 NPI number — FREEDOM RESPIRATORY SOLUTIONS, LLC

Table of content: (NPI 1467603829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467603829 NPI number — FREEDOM RESPIRATORY SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREEDOM RESPIRATORY SOLUTIONS, LLC
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:
PROVIDACARE MEDICAL SUPPLY
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:
1467603829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3724 EXECUTIVE CENTER DR
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78731-1646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-733-6518
Provider Business Mailing Address Fax Number:
512-795-9185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2721 CLEARWATER RD
Provider Second Line Business Practice Location Address:
UNIT 147
Provider Business Practice Location Address City Name:
SAINT CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56301-5952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-257-7000
Provider Business Practice Location Address Fax Number:
320-257-7001
Provider Enumeration Date:
10/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BENNETT
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
512-733-6518

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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