MEDICARE: STONEWALL HOME OXYGEN THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332S00000X	Hearing Aid Equipment

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033546924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONEWALL HOME OXYGEN THERAPY, INC.

Provider Business Mailing Address
First Line	:	456 MARKET PLACE MALL
Second Line	:	SUITE A
City	:	WESTON
State	:	WV
Zip	:	26452-6938
Country	:	US
Telephone Number	:	304-269-0100
Fax Number	:	304-269-4559

Provider Business Practice Location Address
First Line	:	456 MARKET PLACE MALL
Second Line	:	SUITE A
City	:	WESTON
State	:	WV
Zip	:	26452-6938
Country	:	US
Telephone Number	:	304-269-0100
Fax Number	:	304-269-4559

Authorized Official
Title or Position	:	DIRECTOR OF EXTERNAL OPERATIONS
Name	:	MARY JANE EISENBEIS
Credential	:
Telephone Number	:	304-269-0100

Provider Enumeration Date	:	10/09/2013
Last Update Date	:	11/13/2014

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