Provider Demographics
NPI:1033282702
Name:BREATHE EASY OXYGEN SUPPLY, INC.
Entity Type:Organization
Organization Name:BREATHE EASY OXYGEN SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:RHODES
Authorized Official - Last Name:MIRACLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:CRTT
Authorized Official - Phone:904-880-6551
Mailing Address - Street 1:3721 SAN JOSE PLACE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6054
Mailing Address - Country:US
Mailing Address - Phone:904-880-6551
Mailing Address - Fax:904-880-6552
Practice Address - Street 1:3721 SAN JOSE PLACE
Practice Address - Street 2:SUITE 5
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6054
Practice Address - Country:US
Practice Address - Phone:904-880-6551
Practice Address - Fax:904-880-6552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT8185332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1290150001Medicare NSC