Healthcare Provider Details

I. General information

NPI: 1891939674
Provider Name (Legal Business Name): OXYMED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 S CENTRAL AVE
FAIRBORN OH
45324-4716
US

IV. Provider business mailing address

77 S CENTRAL AVE
FAIRBORN OH
45324-4716
US

V. Phone/Fax

Practice location:
  • Phone: 937-372-6200
  • Fax: 937-372-6201
Mailing address:
  • Phone: 937-372-6200
  • Fax: 937-372-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RIC WREN
Title or Position: PRESIDENT
Credential:
Phone: 877-820-9391