Basic Information
| Provider Information | |||||||||
| NPI: | 1275523797 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE OXYGEN COMPANY, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HEALTH FIRST | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8143 STAPLES MILL RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232282751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042662002 | ||||||||
| FaxNumber: | 8042661025 | ||||||||
| Practice Location | |||||||||
| Address1: | 8143 STAPLES MILL RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232282751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042662002 | ||||||||
| FaxNumber: | 8042661025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 11/07/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SALE | ||||||||
| AuthorizedOfficialFirstName: | HORACE | ||||||||
| AuthorizedOfficialMiddleName: | WAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT-CEO | ||||||||
| AuthorizedOfficialTelephone: | 8046738966 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 0206008411 | VA | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 009133429 | 05 | VA | MEDICAID | 063926 | 01 | VA | ANTHEM PROVIDER NUMBER | OTHER | 82-00021 | 01 | VA | UNITED HEALTHCARE | OTHER | 247648 | 01 | VA | MAMSI PROVIDER NUMBER | OTHER | 63046 | 01 | VA | SOUTHERN HEALTH PROVIDER | OTHER | 10393 | 01 | VA | CARENET PROVIDER NUMBER | OTHER |