Provider Demographics
NPI:1013098813
Name:FRESH AIR MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:FRESH AIR MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-916-2816
Mailing Address - Street 1:1415 W MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-4942
Mailing Address - Country:US
Mailing Address - Phone:580-931-3053
Mailing Address - Fax:580-931-3439
Practice Address - Street 1:1415 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-4942
Practice Address - Country:US
Practice Address - Phone:580-931-3053
Practice Address - Fax:580-931-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK231459332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200011020AMedicaid
OK4750840001Medicare NSC