Healthcare Provider Details

I. General information

NPI: 1891779211
Provider Name (Legal Business Name): COMMUNITY OXYGEN SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KUEBEL ST STE C
HARAHAN LA
70123-6961
US

IV. Provider business mailing address

1501 KUEBEL ST, STE C
HARAHAN LA
70123
US

V. Phone/Fax

Practice location:
  • Phone: 504-894-9729
  • Fax:
Mailing address:
  • Phone: 504-894-9729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number360010426
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5087IR
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5087IR
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number5087IR
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number5087IR
License Number StateLA

VIII. Authorized Official

Name: MR. PAUL B KAVANAUGH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 504-899-2500