Provider Demographics
NPI:1376571968
Name:SIERRA OXYGEN SERVICE INC.
Entity Type:Organization
Organization Name:SIERRA OXYGEN SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WENDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-884-1234
Mailing Address - Street 1:200 BATH STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-2459
Mailing Address - Country:US
Mailing Address - Phone:775-884-1234
Mailing Address - Fax:775-884-1241
Practice Address - Street 1:200 BATH STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-2459
Practice Address - Country:US
Practice Address - Phone:775-884-1234
Practice Address - Fax:775-884-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV332BX2000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003313007Medicaid
NV03313007Medicaid
NV003313007Medicaid