Healthcare Provider Details

I. General information

NPI: 1316789951
Provider Name (Legal Business Name): AIRWAY OXYGEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24881 W 10 MILE RD STE A
SOUTHFIELD MI
48033
US

IV. Provider business mailing address

220 W GERMANTOWN PIKE STE 250
PLYMOUTH MEETING PA
19462-1437
US

V. Phone/Fax

Practice location:
  • Phone: 947-426-8565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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