Healthcare Provider Details

I. General information

NPI: 1174628515
Provider Name (Legal Business Name): BEACON RESPIRATORY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 N HIGHWAY 27
SEBRING FL
33870-1216
US

IV. Provider business mailing address

555 E NORTH LN STE 5075
CONSHOHOCKEN PA
19428-2490
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-8464
  • Fax: 863-382-8979
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number3880135741464
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number3204779
License Number StateFL

VIII. Authorized Official

Name: WENDY RUSSALESI
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 484-246-9499