MEDICARE: SECOND WIND ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295728434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND WIND ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	5221A MILITIA HILL RD
Second Line	:
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-1216
Country	:	US
Telephone Number	:	610-941-4555
Fax Number	:	610-941-4557

Provider Business Practice Location Address
First Line	:	5221A MILITIA HILL RD
Second Line	:
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-1216
Country	:	US
Telephone Number	:	610-941-4555
Fax Number	:	610-941-4557

Authorized Official
Title or Position	:	OWNER/VICE PRESIDENT
Name	:	MRS. NAOMI ROUFS EDWARDS
Credential	:
Telephone Number	:	949-640-0330

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	12/29/2009

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