Basic Information
Provider Information | |||||||||
NPI: | 1487848107 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | OXYGEN & MORE, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 115 JOHN MADDOX DR NW | ||||||||
Address2: |   | ||||||||
City: | ROME | ||||||||
State: | GA | ||||||||
PostalCode: | 301651419 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7062901330 | ||||||||
FaxNumber: | 7062901332 | ||||||||
Practice Location | |||||||||
Address1: | 11 S COMMERCE DR | ||||||||
Address2: |   | ||||||||
City: | RINGGOLD | ||||||||
State: | GA | ||||||||
PostalCode: | 307368469 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7068611766 | ||||||||
FaxNumber: | 7068613110 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/06/2007 | ||||||||
LastUpdateDate: | 09/06/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DUNLAP | ||||||||
AuthorizedOfficialFirstName: | EARL | ||||||||
AuthorizedOfficialMiddleName: | WALTON | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 7274241914 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X |   |   | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
No ID Information.