Provider Demographics
NPI:1477648186
Name:GEORGIA OXYGEN SERVICE, INC.
Entity Type:Organization
Organization Name:GEORGIA OXYGEN SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, CPFT, CRTT
Authorized Official - Phone:478-272-4797
Mailing Address - Street 1:112 ROWE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-5200
Mailing Address - Country:US
Mailing Address - Phone:478-272-4797
Mailing Address - Fax:478-272-2271
Practice Address - Street 1:112 ROWE ST
Practice Address - Street 2:SUITE D
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-5200
Practice Address - Country:US
Practice Address - Phone:478-272-4797
Practice Address - Fax:478-272-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BN1400X, 332BP3500X, 332BX2000X
GAPHRE008253333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52192361 001OtherPROVIDER # BLUE CROSS BLU
SC0606090001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER