MEDICARE: SOUTHEASTERN HOME OXYGEN SERVICES

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508815788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEASTERN HOME OXYGEN SERVICES

Provider Business Mailing Address
First Line	:	1112 15TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2210
Country	:	US
Telephone Number	:	706-327-8993
Fax Number	:	706-327-0254

Provider Business Practice Location Address
First Line	:	1112 15TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2210
Country	:	US
Telephone Number	:	706-327-8993
Fax Number	:	706-327-0254

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEREMY F KILLOUGH
Credential	:
Telephone Number	:	706-327-8993

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	08/22/2020

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Directions to “SOUTHEASTERN HOME OXYGEN SERVICES ” Practice Location

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