=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083630479
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AIR OASIS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3401 AIRWAY BLVD
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79118-7742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-373-7788
-----------------------------------------------------
Fax | 806-373-7799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3401 AIRWAY BLVD
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79118-7742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-373-7788
-----------------------------------------------------
Fax | 806-373-7799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ PARTNERSHIP
-----------------------------------------------------
Name | DR. JEFF EDWARD BENNERT
-----------------------------------------------------
Credential | CTN
-----------------------------------------------------
Telephone | 806-373-7788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------