1679563720 NPI number — FRESH AIR OXYGEN AND MEDICAL SUPPLY

Table of content: (NPI 1679563720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679563720 NPI number — FRESH AIR OXYGEN AND MEDICAL SUPPLY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRESH AIR OXYGEN AND MEDICAL SUPPLY
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:
1679563720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1281
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSHALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75671-1281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1306 S WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75670-6216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-927-1135
Provider Business Practice Location Address Fax Number:
903-927-2232
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
THORNTON
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
903-927-1135

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  24241 , 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: 175999501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2098692 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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