=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104996727
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEACON RESPIRATORY SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2006
-----------------------------------------------------
Last Update Date | 10/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4562 MCASHTON ST UNIT 11
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-926-8090
-----------------------------------------------------
Fax | 941-926-8059
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 555 E NORTH LN STE 5075
-----------------------------------------------------
City | CONSHOHOCKEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19428-2490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CCO
-----------------------------------------------------
Name | WENDY RUSSALESI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-246-9499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 6880136388315
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------