Provider Demographics
NPI:1154346732
Name:AIRCARE HOME MEDICAL, INC.
Entity type:Organization
Organization Name:AIRCARE HOME MEDICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-206-0040
Mailing Address - Street 1:3325 BARTLETT BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-6428
Mailing Address - Country:US
Mailing Address - Phone:407-206-0040
Mailing Address - Fax:407-206-0010
Practice Address - Street 1:1703 CHARLESTOWN NEW ALBANY RD STE D&E
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-218-0077
Practice Address - Fax:812-218-0088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AEROCARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-13
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMG0333332B00000X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1142572OtherPASSPORT
KY2438161000OtherPASSPORT ADVANTAGE
KY000000208710OtherANTHEM
KY90003328Medicaid
IN200339580AMedicaid
KY1142572OtherPASSPORT