Healthcare Provider Details

I. General information

NPI: 1154341683
Provider Name (Legal Business Name): MEDICAL OXYGEN SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MANZANARES AVE E
SOCORRO NM
87801-4212
US

IV. Provider business mailing address

PO BOX 1306
SOCORRO NM
87801-1306
US

V. Phone/Fax

Practice location:
  • Phone: 505-835-1230
  • Fax: 505-835-3882
Mailing address:
  • Phone: 505-835-3882
  • Fax: 505-835-3882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. HAROLD C DOTSTON JR.
Title or Position: PARTNER
Credential:
Phone: 505-835-3882