Provider Demographics
NPI:1740342641
Name:AIRWAY HOME MEDICAL EQUIPMENT INC
Entity type:Organization
Organization Name:AIRWAY HOME MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERTON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:337-237-7377
Mailing Address - Street 1:400 W SAINT MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506
Mailing Address - Country:US
Mailing Address - Phone:337-237-7377
Mailing Address - Fax:337-593-0596
Practice Address - Street 1:400 W SAINT MARY BOULEVARD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506
Practice Address - Country:US
Practice Address - Phone:337-237-7377
Practice Address - Fax:337-593-0596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA125555200-01332B00000X
LA332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1188387Medicaid
LA3993040001Medicare NSC