Healthcare Provider Details

I. General information

NPI: 1659365963
Provider Name (Legal Business Name): HAZLETON OXYGEN MEDICAL EQUIPMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512B N CHURCH ST
HAZLETON PA
18202-9503
US

IV. Provider business mailing address

1512B N CHURCH ST
HAZLETON PA
18202-9503
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-4300
  • Fax: 570-459-2100
Mailing address:
  • Phone: 570-459-4300
  • Fax: 570-459-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number82373635
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0019172170001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1423015
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name: MARK A. SCARCELLA
Title or Position: PRESIDENT
Credential:
Phone: 570-459-4300