Provider Demographics
NPI:1558328815
Name:SUNRISE OXYGEN & HOME MEDICAL PRODUCTS, INC.
Entity Type:Organization
Organization Name:SUNRISE OXYGEN & HOME MEDICAL PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKWARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-840-1074
Mailing Address - Street 1:PO BOX 5180
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30916-5180
Mailing Address - Country:US
Mailing Address - Phone:706-793-7001
Mailing Address - Fax:706-793-7040
Practice Address - Street 1:3452 PEACH ORCHARD RD
Practice Address - Street 2:STE D
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-5939
Practice Address - Country:US
Practice Address - Phone:706-793-7001
Practice Address - Fax:706-793-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1148Medicaid
GA1138570001Medicare ID - Type Unspecified