1477648186 NPI number — GEORGIA OXYGEN SERVICE, INC.

Table of content: (NPI 1477648186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477648186 NPI number — GEORGIA OXYGEN SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA OXYGEN SERVICE, 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:
1477648186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 ROWE ST
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31021-5200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-272-4797
Provider Business Mailing Address Fax Number:
478-272-2271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 ROWE ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31021-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-272-4797
Provider Business Practice Location Address Fax Number:
478-272-2271
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
478-272-4797

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PHRE008253 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 52192361 001 . This is a "PROVIDER # BLUE CROSS BLU" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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