1336166867 NPI number — OXYONLY INC

Table of content: (NPI 1336166867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336166867 NPI number — OXYONLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OXYONLY 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:
PROCAIR
Provider Other Organization Name Type Code:
3
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:
1336166867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 W WALNUT HILL LN
Provider Second Line Business Mailing Address:
SUITE 255
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75038-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-580-8294
Provider Business Mailing Address Fax Number:
972-580-8297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 W WALNUT HILL LN
Provider Second Line Business Practice Location Address:
SUITE 255
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75038-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-580-8294
Provider Business Practice Location Address Fax Number:
972-580-8297
Provider Enumeration Date:
07/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CECHIN
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
972-444-8294

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 087347301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515730 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10025624 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 016106901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".