Provider Demographics
NPI:1467622613
Name:PSC INC
Entity Type:Organization
Organization Name:PSC INC
Other - Org Name:PROFESSIONAL HOME OXYGEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-710-3290
Mailing Address - Street 1:PO BOX 734157
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-4157
Mailing Address - Country:US
Mailing Address - Phone:480-495-5644
Mailing Address - Fax:
Practice Address - Street 1:14331 PROTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75373-6539
Practice Address - Country:US
Practice Address - Phone:972-372-0280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0112153-01Medicaid
TX0112153-01Medicaid