1477750966 NPI number — OPTION ONE HOME MEDICAL EQUIPMENT, INC

Table of content: (NPI 1477750966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477750966 NPI number — OPTION ONE HOME MEDICAL EQUIPMENT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTION ONE HOME MEDICAL EQUIPMENT, 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:
1477750966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/31/2011
NPI Reactivation Date:
06/08/2011

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85274-0700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-834-1092
Provider Business Mailing Address Fax Number:
800-574-7750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12176 INDUSTRIAL BLVD STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICTORVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92395-5879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-834-1092
Provider Business Practice Location Address Fax Number:
800-217-7358
Provider Enumeration Date:
06/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JAMISON
Authorized Official First Name:
TERI
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
REGULATORY AFFAIRS MANAGER
Authorized Official Telephone Number:
480-446-9010

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  103598 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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