Healthcare Provider Details

I. General information

NPI: 1578646154
Provider Name (Legal Business Name): OXY PRO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13221 HUGH SEYMOUR LN
OCEAN SPRINGS MS
39564-2288
US

IV. Provider business mailing address

13221 HUGH SEYMOUR LN
OCEAN SPRINGS MS
39564-2288
US

V. Phone/Fax

Practice location:
  • Phone: 228-875-7950
  • Fax: 228-875-7952
Mailing address:
  • Phone: 228-875-7950
  • Fax: 228-875-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number05955 / 11.1
License Number StateMS

VIII. Authorized Official

Name: MR. BRIAN GARRETT DUCHARME
Title or Position: PRESIDENT / CEO
Credential:
Phone: 228-875-7950