1821165325 NPI number — OXY-MED, INC.

Table of content: (NPI 1821165325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821165325 NPI number — OXY-MED, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OXY-MED, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821165325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 237
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64446-0237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-686-2405
Provider Business Mailing Address Fax Number:
660-686-2670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26146 US HWY 59
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64446-0237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-686-2405
Provider Business Practice Location Address Fax Number:
660-686-2670
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEMYER
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
HAROLD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
660-686-2405

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  13602012 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 156350 . This is a "BCBS OF MISSOURI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 9162620 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 336064 . This is a "COMBINED INS COMPANY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0950931 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14188017 . This is a "BCBS OF KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: D0229930001 . This is a "UNITED AMERICAN INS CO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com