Provider Demographics
NPI:1417342387
Name:BREATHE OXYGEN SUPPLY, INC.
Entity type:Organization
Organization Name:BREATHE OXYGEN SUPPLY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-272-0445
Mailing Address - Street 1:6530 SE FORBES AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66619-1446
Mailing Address - Country:US
Mailing Address - Phone:785-272-0445
Mailing Address - Fax:785-272-0227
Practice Address - Street 1:650 CONGRESSIONAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4869
Practice Address - Country:US
Practice Address - Phone:785-841-2200
Practice Address - Fax:785-841-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5-02640332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies