1710342308 NPI number — SOUTHEASTERN HOME OXYGEN SERVICE, INC.

Table of content: (NPI 1710342308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710342308 NPI number — SOUTHEASTERN HOME OXYGEN SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEASTERN HOME 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:
1710342308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4358
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31914-0358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-327-8993
Provider Business Mailing Address Fax Number:
706-327-0254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2310 CRAWFORD RD STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHENIX CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36867-3612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-384-9244
Provider Business Practice Location Address Fax Number:
334-384-9246
Provider Enumeration Date:
12/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KILLOUGH
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
706-327-8993

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  467 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com