1780877852 NPI number — OXFORD MEDICAL SUPPLIES LLC

Table of content: (NPI 1780877852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780877852 NPI number — OXFORD MEDICAL SUPPLIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OXFORD MEDICAL SUPPLIES LLC
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:
1780877852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11863 BENHAM RD
Provider Second Line Business Mailing Address:
SUITE LL
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63138-1308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-438-0033
Provider Business Mailing Address Fax Number:
866-234-0518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11863 BENHAM RD
Provider Second Line Business Practice Location Address:
SUITE LL
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63138-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-438-0033
Provider Business Practice Location Address Fax Number:
866-234-0518
Provider Enumeration Date:
08/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MANU
Authorized Official First Name:
KWAKU
Authorized Official Middle Name:
BOAFO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-438-0033

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  4947120001 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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