Provider Demographics
NPI:1326046863
Name:ACCURATE OXYGEN AND MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:ACCURATE OXYGEN AND MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:928-684-5313
Mailing Address - Street 1:980 N TEGNER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1468
Mailing Address - Country:US
Mailing Address - Phone:928-684-5313
Mailing Address - Fax:928-684-5323
Practice Address - Street 1:980 N TEGNER ST
Practice Address - Street 2:SUITE A
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1468
Practice Address - Country:US
Practice Address - Phone:928-684-5313
Practice Address - Fax:928-684-5323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20020638332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0279840OtherBLUE CROSS BLUE SHIELD
AZ=========OtherEIN
AZ5512330001Medicare NSC