Healthcare Provider Details

I. General information

NPI: 1699139386
Provider Name (Legal Business Name): MONTANA OXYGEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 WEST JEFFERSON
THREE FORKS MT
59752-0787
US

IV. Provider business mailing address

PO BOX 3123
BOZEMAN MT
59772-3123
US

V. Phone/Fax

Practice location:
  • Phone: 406-404-4116
  • Fax:
Mailing address:
  • Phone: 406-404-4116
  • Fax: 406-924-6427

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: MR. MICHAEL LEE LORENZ
Title or Position: CO-OWNER, MANAGER
Credential:
Phone: 406-209-3190