=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033409933
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TX2GO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2011
-----------------------------------------------------
Last Update Date | 04/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 W STEPHEN FOSTER AVE
-----------------------------------------------------
City | BARDSTOWN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40004-1493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-349-6900
-----------------------------------------------------
Fax | 502-349-6901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 449
-----------------------------------------------------
City | CRESTWOOD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40014-0449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-349-6900
-----------------------------------------------------
Fax | 502-349-6901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DON COYLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-349-6900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------