=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205121191
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AIREMED INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2011
-----------------------------------------------------
Last Update Date | 11/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 436-B OSCEOLA AVE.
-----------------------------------------------------
City | JACKSONVILLE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-343-7039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 436-B OSCEOLA AVE.
-----------------------------------------------------
City | JACKSONVILLE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-343-7039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MICAH PFEIFFER COOPER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 90434347039
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------