MEDICARE: BREATHE EASY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	L14000058975	FL

General Provider Information

NPI Number	:	1073933818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREATHE EASY LLC

Provider Business Mailing Address
First Line	:	463688 STATE ROAD 200
Second Line	:	SUITE 1, #106
City	:	YULEE
State	:	FL
Zip	:	32097-0304
Country	:	US
Telephone Number	:	904-548-8283
Fax Number	:

Provider Business Practice Location Address
First Line	:	463688 STATE ROAD 200
Second Line	:	SUITE 1, #106
City	:	YULEE
State	:	FL
Zip	:	32097-0304
Country	:	US
Telephone Number	:	904-548-8283
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CAROLYN E ADAMS
Credential	:	RRT
Telephone Number	:	904-548-8283

Provider Enumeration Date	:	04/20/2014
Last Update Date	:	04/20/2014

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Directions to “BREATHE EASY LLC ” Practice Location

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