Provider Demographics
NPI:1619905205
Name:ACCESS RESPIRATORY SUPPLY, INC
Entity Type:Organization
Organization Name:ACCESS RESPIRATORY SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-590-3770
Mailing Address - Street 1:3350 NW 22ND TER
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-1062
Mailing Address - Country:US
Mailing Address - Phone:954-590-3770
Mailing Address - Fax:954-590-3771
Practice Address - Street 1:3350 NW 22ND TER
Practice Address - Street 2:SUITE 100B
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-1062
Practice Address - Country:US
Practice Address - Phone:954-590-3770
Practice Address - Fax:954-590-3771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
FLPH220543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4499470001Medicare NSC