Provider Demographics
NPI:1568464295
Name:AIRLIFE MEDICAL LLC
Entity Type:Organization
Organization Name:AIRLIFE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:BRAUCKMULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-965-4410
Mailing Address - Street 1:205 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-3403
Mailing Address - Country:US
Mailing Address - Phone:863-965-4410
Mailing Address - Fax:863-965-4412
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-3403
Practice Address - Country:US
Practice Address - Phone:863-965-4410
Practice Address - Fax:863-965-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312636332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030897800Medicaid
FL030897800Medicaid