Provider Demographics
NPI:1902865694
Name:AIR-WAY MEDICAL, INC.
Entity Type:Organization
Organization Name:AIR-WAY MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-412-2793
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93515-0568
Mailing Address - Country:US
Mailing Address - Phone:760-872-1117
Mailing Address - Fax:760-872-3898
Practice Address - Street 1:437 E LINE ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3505
Practice Address - Country:US
Practice Address - Phone:760-872-1117
Practice Address - Fax:760-872-3898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME00556FMedicaid
CA0228760001Medicare ID - Type Unspecified