Organization
A BREATH OF FRESH AIR MEDICAL EQUIPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOYIE ALLEN (OWNER)
(270) 465-0352
Entity
Organization
Contact information
Practice address
6524B OLD LEBANON RD, CAMPBELLSVILLE, KY 42718-8033
(270) 465-0352
(270) 465-9602
Mailing address
6524B OLD LEBANON RD, CAMPBELLSVILLE, KY 42718-8033
(270) 465-0352
(270) 465-9602
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
MG0186
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000259010
ANTHEM
KY
01
—
1168860
PASSPORT HEALTH PLAN
KY
01
—
2440388000
PASSPORT ADVANTAGE
KY
05
—
90005489
—
KY
Enumeration date
07/02/2006
Last updated
07/23/2007
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