Provider Demographics
NPI:1447243019
Name:OXYGEN PLUS CORP
Entity Type:Organization
Organization Name:OXYGEN PLUS CORP
Other - Org Name:OXYGEN PLUS CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-728-0028
Mailing Address - Street 1:900 MCARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2326
Mailing Address - Country:US
Mailing Address - Phone:931-728-0028
Mailing Address - Fax:931-728-0089
Practice Address - Street 1:900 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2326
Practice Address - Country:US
Practice Address - Phone:931-728-0028
Practice Address - Fax:931-728-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN001961332BP3500X, 332BX2000X
333600000X
TN00000038683336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
15495OtherCARECENTRIX
NC0555OtherBOARD OF PHARMACY
TN1454268Medicaid
UT82113751714OtherPHARMACY CLASS E
IDDME18077OtherDURABLE MEDICAL EQUIPMENT
4439089OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TN01961OtherBOARD OF PHARMACY
4057101OtherBCBS
TN00743OtherHEALTH CARE FACILITIES
SC10133OtherBOARD OF PHARMACY
MS10543/11.1OtherMEDICAL EQUIPMENT SUPPLIER
CA57406OtherHOME MEDICAL DEVICE RETAIL REGISTRATION
NVMP00945OtherBOARD OF PHARMACY MEDICAL DEVICES, EQUIPMENT, GAS
MS10543/11.1OtherMEDICAL EQUIPMENT SUPPLIER