1609960236 NPI number — BREATHE OXYGEN SUPPLY, INC.

Table of content: (NPI 1609960236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609960236 NPI number — BREATHE OXYGEN SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREATHE OXYGEN SUPPLY, 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:
Provider Other Organization Name Type Code:
6
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:
1609960236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6530 SE FORBES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66619-1446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-272-0445
Provider Business Mailing Address Fax Number:
785-272-0227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5967 SW 29TH ST
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66614-2537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-272-0445
Provider Business Practice Location Address Fax Number:
785-272-0227
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
CLIFFORD
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
785-272-0445

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100445520A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118099 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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