Healthcare Provider Details

I. General information

NPI: 1275550626
Provider Name (Legal Business Name): OXYMED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W GRIMES LN
BLOOMINGTON IN
47403-3015
US

IV. Provider business mailing address

235 W GRIMES LN
BLOOMINGTON IN
47403-3015
US

V. Phone/Fax

Practice location:
  • Phone: 812-323-2884
  • Fax: 812-323-2718
Mailing address:
  • Phone: 812-323-2884
  • Fax: 812-323-2718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number69000165A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. RIC WREN
Title or Position: PRESIDENT
Credential:
Phone: 877-820-9391