Healthcare Provider Details

I. General information

NPI: 1609696061
Provider Name (Legal Business Name): AIRWAZE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 MONROE AVE
DUNMORE PA
18509-2443
US

IV. Provider business mailing address

1502 DORGALI DR
SARASOTA FL
34238-2836
US

V. Phone/Fax

Practice location:
  • Phone: 941-350-0446
  • Fax:
Mailing address:
  • Phone: 941-350-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. ROBERT FLANNELLY
Title or Position: LLC MEMBER
Credential:
Phone: 941-350-0446