Provider Demographics
NPI:1710934757
Name:PEGASUS AIRWAVE INC.
Entity Type:Organization
Organization Name:PEGASUS AIRWAVE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-975-6808
Mailing Address - Street 1:1180 S.W. 36TH AVE.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069
Mailing Address - Country:US
Mailing Address - Phone:954-975-6808
Mailing Address - Fax:954-252-4210
Practice Address - Street 1:1180 S.W. 36TH AVE.
Practice Address - Street 2:SUITE 103
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069
Practice Address - Country:US
Practice Address - Phone:954-975-6808
Practice Address - Fax:954-252-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1277332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011388801Medicaid
OH0897785Medicaid
WA9038381Medicaid
SCDM0190Medicaid
NY01169240Medicaid
IN100473190AMedicaid
MA1532162Medicaid
MD193026100Medicaid
AL9607650Medicaid
AZ18340001Medicaid
MI2874553Medicaid
CADME01951FMedicaid
CT004144325Medicaid
CO08002180Medicaid
FL25167400Medicaid
GA00528668AMedicaid
VA9108122Medicaid
WV9100192Medicaid
AL9607650Medicaid
FL0417290001Medicare NSC
MD193026100Medicaid