Provider Demographics
NPI:1679760342
Name:AIRVIDA LLC
Entity type:Organization
Organization Name:AIRVIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-325-9989
Mailing Address - Street 1:2921 E FORT LOWELL RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1551
Mailing Address - Country:US
Mailing Address - Phone:520-405-0141
Mailing Address - Fax:520-514-0515
Practice Address - Street 1:2921 E FORT LOWELL RD
Practice Address - Street 2:SUITE 115
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1551
Practice Address - Country:US
Practice Address - Phone:520-405-0141
Practice Address - Fax:520-514-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1951332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6055650001Medicare NSC