Provider Demographics
NPI:1346630993
Name:BIG SOUTH FORK OXYGEN AND MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:BIG SOUTH FORK OXYGEN AND MEDICAL SUPPLIES
Other - Org Name:BUCKEYE HOME HEALTH CENTER, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH
Authorized Official - Phone:931-879-9926
Mailing Address - Street 1:PO BOX 1197
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-1197
Mailing Address - Country:US
Mailing Address - Phone:941-879-9926
Mailing Address - Fax:
Practice Address - Street 1:950 BAKER HWY UNIT 2
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37756-4169
Practice Address - Country:US
Practice Address - Phone:423-663-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN508332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN152469Medicaid