Provider Demographics
NPI:1568563609
Name:MILLENNIUM OXY-MED EQUIPMENT CO
Entity Type:Organization
Organization Name:MILLENNIUM OXY-MED EQUIPMENT CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-571-1906
Mailing Address - Street 1:411 INDUSTRIAL DR
Mailing Address - Street 2:STE 103
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2871
Mailing Address - Country:US
Mailing Address - Phone:972-571-1906
Mailing Address - Fax:
Practice Address - Street 1:411 INDUSTRIAL DR
Practice Address - Street 2:STE 103
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2871
Practice Address - Country:US
Practice Address - Phone:972-571-1906
Practice Address - Fax:972-664-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0069052332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181810601Medicaid
TX181810602Medicaid
TX181810601Medicaid