1588660252 NPI number — OXYGEN, RESPIRATORY & MEDICAL EQUIP, INC

Table of content: (NPI 1588660252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588660252 NPI number — OXYGEN, RESPIRATORY & MEDICAL EQUIP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OXYGEN, RESPIRATORY & MEDICAL EQUIP, 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:
6
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:
1588660252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 E CENTRAL ENTRANCE
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55811-5569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-625-2095
Provider Business Mailing Address Fax Number:
218-625-2096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 E CENTRAL ENTRANCE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55811-5569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-625-2095
Provider Business Practice Location Address Fax Number:
218-625-2096
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
CARIE
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
218-625-2095

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  9584 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 365414100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41725300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 170641 . This is a "UCARE OF MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 82-00304 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1049253 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 93649 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 57S00DI . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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