Provider Demographics
NPI:1790903268
Name:PORTABLE HOME RESPIRATORY INC
Entity Type:Organization
Organization Name:PORTABLE HOME RESPIRATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-768-0336
Mailing Address - Street 1:4990 SW 52ND STREET
Mailing Address - Street 2:SUITE 211
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-5520
Mailing Address - Country:US
Mailing Address - Phone:800-768-0336
Mailing Address - Fax:954-452-7774
Practice Address - Street 1:4990 SW 52ND STREET
Practice Address - Street 2:SUITE 211
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33314-5520
Practice Address - Country:US
Practice Address - Phone:800-768-0336
Practice Address - Fax:954-452-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL591332B00000X
FL3300368332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR6339OtherBLUE CROSS BLUE SHIELD
FL0248280001Medicare NSC