MEDICARE: OXYGEN PLUS CORP

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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	001961	TN
2	3336S0011X	Specialty Pharmacy	0000003868	TN
3	333600000X	Pharmacy
4	332BX2000X	Oxygen Equipment & Supplies (DME)	001961	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15495	OTHER		CARECENTRIX
2	0555	OTHER	NC	BOARD OF PHARMACY
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	82113751714	OTHER	UT	PHARMACY CLASS E
5	DME18077	OTHER	ID	DURABLE MEDICAL EQUIPMENT
6	4439089	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
7	01961	OTHER	TN	BOARD OF PHARMACY
8	4057101	OTHER		BCBS
9	00743	OTHER	TN	HEALTH CARE FACILITIES
10	10133	OTHER	SC	BOARD OF PHARMACY
11	10543/11.1	OTHER	MS	MEDICAL EQUIPMENT SUPPLIER
12	57406	OTHER	CA	HOME MEDICAL DEVICE RETAIL REGISTRATION
13	MP00945	OTHER	NV	BOARD OF PHARMACY MEDICAL DEVICES, EQUIPMENT, GAS

General Provider Information

NPI Number	:	1447243019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OXYGEN PLUS CORP

Provider Business Mailing Address
First Line	:	900 MCARTHUR ST
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-2326
Country	:	US
Telephone Number	:	931-728-0028
Fax Number	:	931-728-0089

Provider Business Practice Location Address
First Line	:	900 MCARTHUR ST
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-2326
Country	:	US
Telephone Number	:	931-728-0028
Fax Number	:	931-728-0089

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THERESA WHITE
Credential	:
Telephone Number	:	931-728-0028

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	03/28/2012

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Directions to “OXYGEN PLUS CORP ” Practice Location

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