MEDICARE: AIRWAY OXYGEN 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	540D10642	OTHER	MI	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417033853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIRWAY OXYGEN INC

Provider Business Mailing Address
First Line	:	555 E NORTH LN STE 5075
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2490
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1396 TRADE CENTRE DR
Second Line	:	UNIT B
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696
Country	:	US
Telephone Number	:	231-932-0399
Fax Number	:	231-932-0453

Authorized Official
Title or Position	:	CCO
Name	:	WENDY RUSSALESI
Credential	:
Telephone Number	:	484-246-9499

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	04/15/2026

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Directions to “AIRWAY OXYGEN INC ” Practice Location

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