Basic Information
| Provider Information | |||||||||
| NPI: | 1629389671 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AIRWAY OXYGEN INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9950 | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495099918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162473900 | ||||||||
| FaxNumber: | 6162470776 | ||||||||
| Practice Location | |||||||||
| Address1: | 3730 METRO DR N | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468188474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604829875 | ||||||||
| FaxNumber: | 2604835268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2010 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | GRIGGS | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4072060040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AEROCARE HOLDINGS, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | 69000694A | IN | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332BX2000X | 69000694A | IN | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 200859970B | 05 | IN | MEDICAID |