Basic Information
Provider Information | |||||||||
NPI: | 1245539105 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PROCAIR INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 24000 BROADWAY AVE | ||||||||
Address2: |   | ||||||||
City: | OAKWOOD VILLAGE | ||||||||
State: | OH | ||||||||
PostalCode: | 441466329 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4402323000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 235 S CATHERINE ST | ||||||||
Address2: |   | ||||||||
City: | MONTOUR FALLS | ||||||||
State: | NY | ||||||||
PostalCode: | 148659515 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4407353253 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/17/2011 | ||||||||
LastUpdateDate: | 07/24/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LOWERY | ||||||||
AuthorizedOfficialFirstName: | WARREN | ||||||||
AuthorizedOfficialMiddleName: | DARREL | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 4402323000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | MEDICAL SERVICE COMPANIES | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X |   |   | N |   | Suppliers | Durable Medical Equipment & Medical Supplies |   | 332BP3500X |   |   | N |   | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 335E00000X |   |   | N |   | Suppliers | Prosthetic/Orthotic Supplier |   | 332BX2000X |   |   | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
No ID Information.