MEDICARE: MY OXYGEN CO. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1386643443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY OXYGEN CO. INC.

Provider Business Mailing Address
First Line	:	PO BOX 1183
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-0183
Country	:	US
Telephone Number	:	866-696-9943
Fax Number	:	989-839-2970

Provider Business Practice Location Address
First Line	:	1201 E RICHMOND ST
Second Line	:
City	:	SHAWANO
State	:	WI
Zip	:	54166-2645
Country	:	US
Telephone Number	:	866-696-9943
Fax Number	:	989-839-2970

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAMES TODD BRAGIEL
Credential	:
Telephone Number	:	989-233-0119

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	08/22/2020

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