MEDICARE: PREMIERE OXYGEN, LLC

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	MP00369	NV

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	:	1386694479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIERE OXYGEN, LLC

Provider Business Mailing Address
First Line	:	3107 N DEER RUN RD
Second Line	:	STE. 14
City	:	CARSON CITY
State	:	NV
Zip	:	89701
Country	:	US
Telephone Number	:	775-883-2004
Fax Number	:	775-884-4550

Provider Business Practice Location Address
First Line	:	3107 N DEER RUN RD
Second Line	:	STE. 14
City	:	CARSON CITY
State	:	NV
Zip	:	89701-2406
Country	:	US
Telephone Number	:	775-883-2004
Fax Number	:	775-884-4550

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JENNIFER K WENDELL
Credential	:
Telephone Number	:	775-883-2004

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	12/22/2008

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Directions to “PREMIERE OXYGEN, LLC ” Practice Location

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