Basic Information
| Provider Information | |||||||||
| NPI: | 1093789901 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDCO RESPIRATORY INSTRUMENTS, INC. | ||||||||
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| OtherOrganizationName: | AVEANNA HEALTHCARE MEDICAL SOLUTIONS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 INTERSTATE NORTH PKWY SE STE 1600 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303395047 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9331 HWY 6 N | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668831188 | ||||||||
| FaxNumber: | 8338967003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | AFSHAR | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4704648000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | TX | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332B00000X | TX | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 015527701 | 05 | TX | MEDICAID | 015527702 | 01 | TX | CHSCN | OTHER | 121704401 | 05 | TX | MEDICAID |