Healthcare Provider Details

I. General information

NPI: 1083644140
Provider Name (Legal Business Name): WATERVILLE HOME OXYGEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 COLLEGE AVE
WATERVILLE ME
04901-5604
US

IV. Provider business mailing address

84 COLLEGE AVE
WATERVILLE ME
04901-5604
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-0500
  • Fax: 207-872-9500
Mailing address:
  • Phone: 207-872-0500
  • Fax: 207-872-9500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE JOAN TURNER
Title or Position: MEMBER/RESPIRATORY THERAPIST
Credential: R.R.T
Phone: 207-872-0500