=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528097425
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PULMOCAIR RESPIRATORY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 09/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 755 NW 17TH AVE 106
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33445-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-274-9664
-----------------------------------------------------
Fax | 561-265-4320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 755 NW 17TH AVE 106
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33445-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-274-9664
-----------------------------------------------------
Fax | 561-265-4320
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JONATHAN JAMES FEDELE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-274-9664
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 1313247
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------