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General NPI Number Information
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NPI Number | 1720477375
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Entity Type | Organization
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Legal Business Name | PURE AIR OXYGEN SUPPLY, LLC
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 1152 E 2ND ST SUITE C
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City | ALICE
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State | TX
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Zip | 78332-5016
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Country | US
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Telephone | 361-453-7416
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Fax | 361-453-7431
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Provider Business Mailing Address
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Address Line | 1152 E 2ND ST SUITE C
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City | ALICE
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State | TX
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Zip | 78332-5016
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Country | US
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Telephone | 361-453-7416
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Fax | 361-453-7431
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Authorized Official
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Title or Position | OWNER
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Name | MR. LEONEL RIVERA
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Credential | RN-BSN
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Telephone | 361-563-3352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 1001143
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License Number State | TX
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