MEDICARE: PORTABLE HOME RESPIRATORY 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	3300368	FL
2	332B00000X	Durable Medical Equipment & Medical Supplies	591	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R6339	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1790903268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTABLE HOME RESPIRATORY INC

Provider Business Mailing Address
First Line	:	4990 SW 52ND STREET
Second Line	:	SUITE 211
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33314-5520
Country	:	US
Telephone Number	:	800-768-0336
Fax Number	:	954-452-7774

Provider Business Practice Location Address
First Line	:	4990 SW 52ND STREET
Second Line	:	SUITE 211
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33314-5520
Country	:	US
Telephone Number	:	800-768-0336
Fax Number	:	954-452-7774

Authorized Official
Title or Position	:	OWNER OFFICER
Name	:	MS. EDITH E SELBY
Credential	:
Telephone Number	:	800-768-0336

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	12/12/2007

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Directions to “PORTABLE HOME RESPIRATORY INC ” Practice Location

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