Healthcare Provider Details

I. General information

NPI: 1114044831
Provider Name (Legal Business Name): BEACON RESPIRATORY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 S MCCALL RD SUITE 26
ENGLEWOOD FL
34224
US

IV. Provider business mailing address

3325 BARTLETT BLVD
ORLANDO FL
32811-6428
US

V. Phone/Fax

Practice location:
  • Phone: 941-475-6614
  • Fax: 941-475-6625
Mailing address:
  • Phone: 407-206-0040
  • Fax: 407-206-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN P GRIGGS
Title or Position: CEO
Credential:
Phone: 407-206-0040