Provider Demographics
NPI:1437193562
Name:WILLOWCREEK OXYGEN AND MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:WILLOWCREEK OXYGEN AND MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:IBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-871-0999
Mailing Address - Street 1:PO BOX 776276
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-6276
Mailing Address - Country:US
Mailing Address - Phone:970-871-0999
Mailing Address - Fax:
Practice Address - Street 1:2620 S COPPER FRONTAGE RD UNIT 4
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-4977
Practice Address - Country:US
Practice Address - Phone:970-871-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20626860Medicaid
CO20626860Medicaid