MEDICARE: PULMONARY HOME CARE, 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

General Provider Information

NPI Number	:	1952485435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULMONARY HOME CARE, INC.

Provider Business Mailing Address
First Line	:	5150 PLAINFIELD AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-1049
Country	:	US
Telephone Number	:	616-364-4044
Fax Number	:	616-364-4047

Provider Business Practice Location Address
First Line	:	5150 PLAINFIELD AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-1049
Country	:	US
Telephone Number	:	616-364-4044
Fax Number	:	616-364-4047

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GORDON L PRESTON
Credential	:	CRT
Telephone Number	:	616-364-4044

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	08/22/2020

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