Provider Demographics
NPI:1023254216
Name:FREEDOM RESPIRATORY SOLUTIONS, LLC
Entity type:Organization
Organization Name:FREEDOM RESPIRATORY SOLUTIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHANDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-727-5555
Mailing Address - Street 1:831 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2103
Mailing Address - Country:US
Mailing Address - Phone:512-733-6518
Mailing Address - Fax:512-795-9185
Practice Address - Street 1:601 HIGHWAY 10 E
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-4127
Practice Address - Country:US
Practice Address - Phone:218-844-2273
Practice Address - Fax:218-844-2279
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDACARE MEDICAL SUPPLY, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-18
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5882100003Medicare NSC