Provider Demographics
NPI:1972514040
Name:SCM TRUE AIR TECHNOLOGIES, INC.
Entity Type:Organization
Organization Name:SCM TRUE AIR TECHNOLOGIES, INC.
Other - Org Name:SCM LIFE OXYGEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-368-0000
Mailing Address - Street 1:5700 POPLAR LEVEL RD.
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-1044
Mailing Address - Country:US
Mailing Address - Phone:502-368-0000
Mailing Address - Fax:502-368-5334
Practice Address - Street 1:5700 POPLAR LEVEL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40228-1044
Practice Address - Country:US
Practice Address - Phone:502-368-0000
Practice Address - Fax:502-368-5334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY191111332B00000X, 332B00000X, 332BP3500X, 332BX2000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1068522OtherPASSPORT HEALTH PLAN
KY0470930001Medicare ID - Type Unspecified
KY90002148Medicaid
KY90002148Medicaid