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General NPI Number Information
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NPI Number | 1972740397
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Entity Type | Organization
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Legal Business Name | STAR VALLEY HOME OXYGEN
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 10/05/2009
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Provider Practice Location Address
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Address Line | 118 S MAIN ST
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City | THAYNE
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State | WY
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Zip | 83127
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Country | US
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Telephone | 307-883-3445
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Fax | 307-883-7584
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Provider Business Mailing Address
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Address Line | 118 S. MAIN ST.
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City | THAYNE
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State | WY
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Zip | 83127
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Country | US
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Telephone | 307-883-3445
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Fax | 307-883-7584
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Authorized Official
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Title or Position | OWNER
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Name | CRAIG KENNETH WALTHER
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Credential |
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Telephone | 307-883-3445
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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 |
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License Number State |
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