Provider Demographics
NPI:1649208224
Name:FRESH AIR MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:FRESH AIR MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:KALEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-335-3475
Mailing Address - Street 1:103 W BOUNDARY AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-2757
Mailing Address - Country:US
Mailing Address - Phone:318-628-4447
Mailing Address - Fax:318-628-4430
Practice Address - Street 1:103 W BOUNDARY AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-2757
Practice Address - Country:US
Practice Address - Phone:318-628-4447
Practice Address - Fax:318-628-4430
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
LA10745332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0652600001Medicare ID - Type Unspecified