Provider Demographics
NPI:1083672323
Name:TG OXYGEN LLC
Entity Type:Organization
Organization Name:TG OXYGEN LLC
Other - Org Name:ARIZONA HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-252-5000
Mailing Address - Street 1:1626 S EDWARD DR
Mailing Address - Street 2:SUITE #405
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6200
Mailing Address - Country:US
Mailing Address - Phone:602-252-5000
Mailing Address - Fax:602-323-5070
Practice Address - Street 1:1110 E PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1666
Practice Address - Country:US
Practice Address - Phone:520-295-1111
Practice Address - Fax:520-295-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ532332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5292630001Medicare ID - Type Unspecified