Provider Demographics
NPI:1427003201
Name:SPECIALIZED OXYGEN SERVICES, LLC
Entity Type:Organization
Organization Name:SPECIALIZED OXYGEN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT (CO-OWNER)
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DENEISE
Authorized Official - Last Name:STANDEFER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS
Authorized Official - Phone:423-847-0031
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-0965
Mailing Address - Country:US
Mailing Address - Phone:423-847-0031
Mailing Address - Fax:423-847-0525
Practice Address - Street 1:1008 EXECUTIVE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3991
Practice Address - Country:US
Practice Address - Phone:423-847-0031
Practice Address - Fax:423-847-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000727332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000974366AOtherDME PROVIDER # GAMCAID
TN1454230Medicaid
TN4049414OtherDME PROVIDER # BC/BS
TN1454230Medicaid