Provider Demographics
NPI:1457375933
Name:FRESH AIR RESPIRATORY CARE, INC.
Entity Type:Organization
Organization Name:FRESH AIR RESPIRATORY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, RCP
Authorized Official - Phone:704-868-8881
Mailing Address - Street 1:645 COX RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0648
Mailing Address - Country:US
Mailing Address - Phone:704-868-8881
Mailing Address - Fax:704-868-8882
Practice Address - Street 1:645 COX RD
Practice Address - Street 2:SUITE C
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0648
Practice Address - Country:US
Practice Address - Phone:704-868-8881
Practice Address - Fax:704-868-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01161332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704540Medicaid
5755760001Medicare NSC