Provider Demographics
NPI:1235171687
Name:PULMOCAIR RESPIRATORY, INC,
Entity Type:Organization
Organization Name:PULMOCAIR RESPIRATORY, INC,
Other - Org Name:PULMOCAIR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-274-9664
Mailing Address - Street 1:755 NW 17TH AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2522
Mailing Address - Country:US
Mailing Address - Phone:561-274-9664
Mailing Address - Fax:561-274-7000
Practice Address - Street 1:82 SPRUCE ST
Practice Address - Street 2:SUITE 121
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2150
Practice Address - Country:US
Practice Address - Phone:270-767-1519
Practice Address - Fax:866-233-9219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP070953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4309420003Medicare NSC