Provider Demographics
NPI:1033174289
Name:OXYLIFE RESPIRATORY SERVICES, LLC
Entity Type:Organization
Organization Name:OXYLIFE RESPIRATORY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:EWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-873-2971
Mailing Address - Street 1:6405 SW 38TH ST
Mailing Address - Street 2:#101-104
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-6539
Mailing Address - Country:US
Mailing Address - Phone:352-873-2971
Mailing Address - Fax:352-873-2972
Practice Address - Street 1:6405 SW 38TH ST
Practice Address - Street 2:#101-104
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-6539
Practice Address - Country:US
Practice Address - Phone:352-873-2971
Practice Address - Fax:352-873-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1731332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026137800Medicaid
FLR9317OtherBLUE CROSS & BLUE SHIELD
FLR9317OtherBLUE CROSS & BLUE SHIELD