Provider Demographics
NPI:1477750966
Name:OPTION ONE HOME MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:OPTION ONE HOME MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGULATORY AFFAIRS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-446-9010
Mailing Address - Street 1:PO BOX 40700
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85274-0700
Mailing Address - Country:US
Mailing Address - Phone:800-834-1092
Mailing Address - Fax:800-574-7750
Practice Address - Street 1:12176 INDUSTRIAL BLVD STE 5
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5879
Practice Address - Country:US
Practice Address - Phone:800-834-1092
Practice Address - Fax:800-217-7358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2011-06-08
Deactivation Date:2011-03-31
Deactivation Code:
Reactivation Date:2011-06-08
Provider Licenses
StateLicense IDTaxonomies
CA103598332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1095710005Medicare NSC