Provider Demographics
NPI:1477623254
Name:PROFESSIONAL OXYGEN SUPPLY INC.
Entity Type:Organization
Organization Name:PROFESSIONAL OXYGEN SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:RONEICE
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:307-328-1357
Mailing Address - Street 1:417 W BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5621
Mailing Address - Country:US
Mailing Address - Phone:307-328-1357
Mailing Address - Fax:
Practice Address - Street 1:1804 DUNDEE DR
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301
Practice Address - Country:US
Practice Address - Phone:307-328-1357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY303840OtherBCBS PROVIDER NUMBER
WY0876940001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER