Healthcare Provider Details

I. General information

NPI: 1679538920
Provider Name (Legal Business Name): O2 ETC., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 21ST AVE
HOLLYWOOD FL
33020-4522
US

IV. Provider business mailing address

111 S 21ST AVE
HOLLYWOOD FL
33020-4522
US

V. Phone/Fax

Practice location:
  • Phone: 954-792-7902
  • Fax: 954-792-0217
Mailing address:
  • Phone: 954-792-7902
  • Fax: 954-792-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH19282
License Number StateFL

VIII. Authorized Official

Name: MR. ROBERT SNYDER
Title or Position: CEO
Credential:
Phone: 954-792-7902