Healthcare Provider Details

I. General information

NPI: 1336205814
Provider Name (Legal Business Name): SUNSHINE OXYGEN SERVICE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 LAKESIDE DR
LOLO MT
59847-9706
US

IV. Provider business mailing address

1104 LAKESIDE DR
LOLO MT
59847-9706
US

V. Phone/Fax

Practice location:
  • Phone: 406-549-3980
  • Fax:
Mailing address:
  • Phone: 406-549-3980
  • Fax:

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: PATTY AGNES LESTER
Title or Position: PRESIDENT
Credential: LPN AND CPA
Phone: 406-549-3980