MEDICARE: AZLE OXYGEN SUPPLY

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)	0036196	TX

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	:	1831171008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZLE OXYGEN SUPPLY

Provider Business Mailing Address
First Line	:	1129 SOUTHEAST PKWY
Second Line	:
City	:	AZLE
State	:	TX
Zip	:	76020-3803
Country	:	US
Telephone Number	:	817-238-8989
Fax Number	:	817-238-8998

Provider Business Practice Location Address
First Line	:	1129 SOUTHEAST PKWY
Second Line	:
City	:	AZLE
State	:	TX
Zip	:	76020-3803
Country	:	US
Telephone Number	:	817-238-8989
Fax Number	:	817-238-8998

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. ROBIN KEITH VARNES
Credential	:
Telephone Number	:	817-238-8989

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	08/19/2008

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Directions to “AZLE OXYGEN SUPPLY ” Practice Location

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