Healthcare Provider Details

I. General information

NPI: 1366861536
Provider Name (Legal Business Name): BREATH OF LIFE O2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17005 WESTFIELD PARK RD SUITE 1
WESTFIELD IN
46074-8428
US

IV. Provider business mailing address

430 ALPHA DR SUITE 100
WESTFIELD IN
46074-7000
US

V. Phone/Fax

Practice location:
  • Phone: 317-896-3048
  • Fax: 866-611-5501
Mailing address:
  • Phone: 317-896-3048
  • Fax: 866-611-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOHN PHILLIP NAUYOKAS
Title or Position: PRESIDENT/CEO
Credential: CRT CPT
Phone: 317-896-3048