Provider Demographics
NPI:1073521407
Name:OXYAIR MEDICAL LLC
Entity Type:Organization
Organization Name:OXYAIR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BOUCHARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:860-677-2122
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-0158
Mailing Address - Country:US
Mailing Address - Phone:860-677-2122
Mailing Address - Fax:860-677-2419
Practice Address - Street 1:471 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1438
Practice Address - Country:US
Practice Address - Phone:860-677-2122
Practice Address - Fax:860-677-2419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5767010001Medicare NSC