Provider Demographics
NPI:1164729943
Name:TG OXYGEN, LLC
Entity Type:Organization
Organization Name:TG OXYGEN, LLC
Other - Org Name:FAIRWAY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLIMCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-231-8849
Mailing Address - Street 1:943 S 48TH ST
Mailing Address - Street 2:104
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5123
Mailing Address - Country:US
Mailing Address - Phone:480-347-9190
Mailing Address - Fax:877-620-9804
Practice Address - Street 1:943 S 48TH ST
Practice Address - Street 2:104
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5123
Practice Address - Country:US
Practice Address - Phone:480-347-9190
Practice Address - Fax:877-620-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
AZ332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies