Healthcare Provider Details

I. General information

NPI: 1891983672
Provider Name (Legal Business Name): OXYGEN PLUS, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BETSY PACK DR
JASPER TN
37347-3317
US

IV. Provider business mailing address

307 BETSY PACK DR
JASPER TN
37347-3317
US

V. Phone/Fax

Practice location:
  • Phone: 423-742-0711
  • Fax:
Mailing address:
  • Phone: 423-742-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0000001961
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number3868
License Number StateTN

VIII. Authorized Official

Name: THERESA C MCLEAN
Title or Position: CEO
Credential:
Phone: 615-320-1011