1063593804 NPI number — QUALITY HOME OXYGEN, INC.

Table of content: (NPI 1063593804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063593804 NPI number — QUALITY HOME OXYGEN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY HOME OXYGEN, 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:
1063593804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 W HICKORY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCHATOULA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70454-3215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-386-4760
Provider Business Mailing Address Fax Number:
985-386-4761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCCOMB
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39648-3939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-684-9386
Provider Business Practice Location Address Fax Number:
601-684-1055
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
601-684-8923

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  02453-11.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00440119 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1981915 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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