MEDICARE: SOUTHEAST OXYGEN, 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	332B00000X	Durable Medical Equipment & Medical Supplies	1396	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R9277	OTHER	FL	BC & BS OF FL

General Provider Information

NPI Number	:	1306884010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST OXYGEN, INC.

Provider Business Mailing Address
First Line	:	1829 S DIXIE HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-8916
Country	:	US
Telephone Number	:	954-941-1288
Fax Number	:	954-941-3380

Provider Business Practice Location Address
First Line	:	1829 S DIXIE HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-8916
Country	:	US
Telephone Number	:	954-941-1288
Fax Number	:	954-941-3380

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	SUSAN D MAJAVA
Credential	:
Telephone Number	:	954-303-7012

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	08/22/2020

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Directions to “SOUTHEAST OXYGEN, INC. ” Practice Location

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