Provider Demographics
NPI:1467603829
Name:FREEDOM RESPIRATORY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:FREEDOM RESPIRATORY SOLUTIONS, LLC
Other - Org Name:PROVIDACARE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-733-6518
Mailing Address - Street 1:3724 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1646
Mailing Address - Country:US
Mailing Address - Phone:512-733-6518
Mailing Address - Fax:512-795-9185
Practice Address - Street 1:2721 CLEARWATER RD
Practice Address - Street 2:UNIT 147
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-5952
Practice Address - Country:US
Practice Address - Phone:320-257-7000
Practice Address - Fax:320-257-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5882100004Medicare NSC