Provider Demographics
NPI:1164671863
Name:SOUND OXYGEN SERVICE INC
Entity Type:Organization
Organization Name:SOUND OXYGEN SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-939-2752
Mailing Address - Street 1:4108 B PL NW
Mailing Address - Street 2:STE B
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-2454
Mailing Address - Country:US
Mailing Address - Phone:253-939-2752
Mailing Address - Fax:253-939-4135
Practice Address - Street 1:930 S STATE ST
Practice Address - Street 2:STE 120
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7006
Practice Address - Country:US
Practice Address - Phone:801-696-8617
Practice Address - Fax:801-766-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7017897-1714332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1164671863Medicaid
UT7017897-1714OtherUTAH PHARMACY BOARD
UT4992000003Medicare NSC