MEDICARE: SOUTHERN NEVADA 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	332BX2000X	Oxygen Equipment & Supplies (DME)	MP00134	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	:	1427130715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN NEVADA OXYGEN, INC.

Provider Business Mailing Address
First Line	:	3325 BARTLETT BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-6428
Country	:	US
Telephone Number	:	407-206-0040
Fax Number	:	407-206-0010

Provider Business Practice Location Address
First Line	:	3069 S VALLEY VIEW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-7889
Country	:	US
Telephone Number	:	702-696-1313
Fax Number	:	702-696-0133

Authorized Official
Title or Position	:	CEO/ PRESIDENT
Name	:	MR. STEPHEN P. GRIGGS
Credential	:
Telephone Number	:	407-206-0040

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	04/26/2019

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Directions to “SOUTHERN NEVADA OXYGEN, INC. ” Practice Location

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