Healthcare Provider Details

I. General information

NPI: 1316955560
Provider Name (Legal Business Name): AUSTIN RESPIRATORY AND MEDICAL EQUIPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 WARD ST W
DOUGLAS GA
31533-3506
US

IV. Provider business mailing address

502 WARD ST W
DOUGLAS GA
31533-3506
US

V. Phone/Fax

Practice location:
  • Phone: 912-384-4771
  • Fax: 912-384-0039
Mailing address:
  • Phone: 912-384-4771
  • Fax: 912-384-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number00080
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number000080
License Number StateGA

VIII. Authorized Official

Name: MR. LUKE AUSTIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 912-384-4771