Provider Demographics
NPI:1457417354
Name:AIRWAY OXYGEN, INC.
Entity Type:Organization
Organization Name:AIRWAY OXYGEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:NYHUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-532-2375
Mailing Address - Street 1:PO BOX 9950
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9918
Mailing Address - Country:US
Mailing Address - Phone:616-247-3900
Mailing Address - Fax:616-247-0776
Practice Address - Street 1:1804 E CENTER ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3604
Practice Address - Country:US
Practice Address - Phone:574-268-0042
Practice Address - Fax:574-268-0084
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRANITE HOLDINGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-28
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0475550015Medicare NSC