Provider Demographics
NPI:1154509214
Name:SPECIALIZED OXYGEN SERVICES, LLC
Entity Type:Organization
Organization Name:SPECIALIZED OXYGEN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DENEISE
Authorized Official - Last Name:STANDEFER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS
Authorized Official - Phone:423-802-5143
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-0965
Mailing Address - Country:US
Mailing Address - Phone:423-847-0031
Mailing Address - Fax:
Practice Address - Street 1:1300 25TH ST NW
Practice Address - Street 2:SUITE 2
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3614
Practice Address - Country:US
Practice Address - Phone:423-476-7940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALIZED OXYGEN SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-31
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000727332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4601560002Medicare NSC