Healthcare Provider Details

I. General information

NPI: 1902908114
Provider Name (Legal Business Name): MED-OX HOME MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 N BRIDGE ST
CHILLICOTHEE OH
45601-2616
US

IV. Provider business mailing address

4867 URBANA RD
SPRINGFIELD OH
45502-9503
US

V. Phone/Fax

Practice location:
  • Phone: 740-772-5764
  • Fax: 740-773-3046
Mailing address:
  • Phone: 937-323-5764
  • Fax: 937-323-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number11065
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberHMEL11065
License Number StateOH

VIII. Authorized Official

Name: MR. MARK A SMITH
Title or Position: MANAGING MEMBER
Credential:
Phone: 937-323-5764