MEDICARE: AIRWAY SUPPORT SOLUTION 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

General Provider Information

NPI Number	:	1477589679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIRWAY SUPPORT SOLUTION LLC

Provider Business Mailing Address
First Line	:	5500 E LOOP 820 S
Second Line	:	# 109
City	:	FORT FORTH
State	:	TX
Zip	:	76119
Country	:	US
Telephone Number	:	817-563-2880
Fax Number	:	817-345-3528

Provider Business Practice Location Address
First Line	:	5500 E LOOP 820 S
Second Line	:	SUITE 109
City	:	FORT WORTH
State	:	TX
Zip	:	76119-6569
Country	:	US
Telephone Number	:	817-563-2880
Fax Number	:	817-345-3528

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. JEYNI AGUILAR
Credential	:
Telephone Number	:	817-563-2880

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	06/10/2008

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Directions to “AIRWAY SUPPORT SOLUTION LLC ” Practice Location

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