Provider Demographics
NPI:1861487373
Name:DAVID PETSCH ENTERPRISES, INC.
Entity Type:Organization
Organization Name:DAVID PETSCH ENTERPRISES, INC.
Other - Org Name:PETSCH RESPIRATORY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHADWICK
Authorized Official - Middle Name:KEEBLE
Authorized Official - Last Name:MCCRICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-863-6252
Mailing Address - Street 1:3845 MARTINEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2666
Mailing Address - Country:US
Mailing Address - Phone:706-863-6252
Mailing Address - Fax:706-863-2337
Practice Address - Street 1:3845 MARTINEZ BLVD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-2666
Practice Address - Country:US
Practice Address - Phone:706-863-6252
Practice Address - Fax:706-863-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20012830780332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00850726AMedicaid
SCDE1565Medicaid
GA00850726AMedicaid