Provider Demographics
NPI:1609013747
Name:BREATH OF LIFE O2 LLC.
Entity type:Organization
Organization Name:BREATH OF LIFE O2 LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:NAUYOKAS
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:317-896-3048
Mailing Address - Street 1:17005 WESTFIELD PARK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8428
Mailing Address - Country:US
Mailing Address - Phone:317-896-3048
Mailing Address - Fax:866-611-5501
Practice Address - Street 1:17005 WESTFIELD PARK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8428
Practice Address - Country:US
Practice Address - Phone:317-896-3048
Practice Address - Fax:866-611-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6219550001OtherMEDICARE PTAN
IN200935180AMedicaid
6219550001OtherMEDICARE PTAN