David Petsch Enterprises, Inc.

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

20012830780 Issued in GA

Legal business name

DAVID PETSCH ENTERPRISES, INC.

Doing business as

Petsch Respiratory Services

Practice address

3845 Martinez Blvd
Martinez, GA 30907-2666

Phone

(706) 863-6252

Fax

(706) 863-2337

NPI assigned

Sep 12, 2005

Last updated

Jun 11, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Chadwick Keeble McCrickard

Title

President

Phone

(706) 863-6252

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Petsch Respiratory Services Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623369600000",
    "number": "1861487373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3845 MARTINEZ BLVD",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309072666",
            "telephone_number": "706-863-6252",
            "fax_number": "706-863-2337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3845 MARTINEZ BLVD",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309072666",
            "telephone_number": "706-863-6252",
            "fax_number": "706-863-2337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID PETSCH ENTERPRISES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-12",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A",
        "authorized_official_last_name": "MCCRICKARD",
        "authorized_official_first_name": "CHADWICK",
        "authorized_official_middle_name": "KEEBLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-863-6252",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "GA",
            "license": "20012830780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00850726A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DE1565",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Petsch Respiratory Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Petsch Respiratory Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Oxygen Equipment & Supplies (DME) in Martinez, GA
• Providers in Martinez, GA by specialty
• Oxygen Equipment & Supplies (DME) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.