Basic Information
| Provider Information | |||||||||
| NPI: | 1215932827 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAULT OXYGEN, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | RIVER CITIES OXYGEN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 832 | ||||||||
| Address2: | |||||||||
| City: | SAULT SAINTE MARIE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497830832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9062531721 | ||||||||
| FaxNumber: | 9062531722 | ||||||||
| Practice Location | |||||||||
| Address1: | 1122 E EASTERDAY AVE | ||||||||
| Address2: | |||||||||
| City: | SAULT SAINTE MARIE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497832334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9062531721 | ||||||||
| FaxNumber: | 9062531722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 08/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | BBELLEAU | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 9062531721 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 54O-A702630 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER |