Provider Demographics
NPI:1447289327
Name:A BREATH OF FRESH AIR MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:A BREATH OF FRESH AIR MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOYIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-465-0352
Mailing Address - Street 1:6524B OLD LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8033
Mailing Address - Country:US
Mailing Address - Phone:270-465-0352
Mailing Address - Fax:270-465-9602
Practice Address - Street 1:6524B OLD LEBANON RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-8033
Practice Address - Country:US
Practice Address - Phone:270-465-0352
Practice Address - Fax:270-465-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMG0186332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1168860OtherPASSPORT HEALTH PLAN
KY90005489Medicaid
KY000000259010OtherANTHEM
KY2440388000OtherPASSPORT ADVANTAGE
KY1168860OtherPASSPORT HEALTH PLAN