Basic Information
| Provider Information | |||||||||
| NPI: | 1679637102 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED HEALTHCARE SYSTEMS, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DBA AUBURN OXYGEN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8730 HARRIS RD | ||||||||
| Address2: | UNIT 204 | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933118990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613963720 | ||||||||
| FaxNumber: | 6618326009 | ||||||||
| Practice Location | |||||||||
| Address1: | 213 NORTH ST | ||||||||
| Address2: | UNIT C | ||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130211246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152524768 | ||||||||
| FaxNumber: | 3152524819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 07/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | KANE | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4158931518 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 02769033 | 05 | NY | MEDICAID |