MEDICARE: RESPIRATORY SERVICES OF NORTHWEST FLORIDA, INC.

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	7097	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336141589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESPIRATORY SERVICES OF NORTHWEST FLORIDA, INC.

Provider Business Mailing Address
First Line	:	502 E PINE AVE STE B
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32539-2818
Country	:	US
Telephone Number	:	850-689-5499
Fax Number	:	850-689-5404

Provider Business Practice Location Address
First Line	:	502 E PINE AVE STE B
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32539-2818
Country	:	US
Telephone Number	:	850-689-5499
Fax Number	:	850-689-5404

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. NANCY E ENFINGER
Credential	:	RRT
Telephone Number	:	850-689-5499

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/26/2011

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