Healthcare Provider Details

I. General information

NPI: 1578247078
Provider Name (Legal Business Name): RESTORATIVE OXYGEN CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3499 BLAZER PKWY STE 35
LEXINGTON KY
40509-2798
US

IV. Provider business mailing address

3499 BLAZER PKWY STE 35
LEXINGTON KY
40509-2812
US

V. Phone/Fax

Practice location:
  • Phone: 859-420-6362
  • Fax:
Mailing address:
  • Phone: 859-420-6362
  • Fax: 859-303-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAUL RAYMOND DIERUF
Title or Position: OWNER
Credential:
Phone: 859-420-6362