Provider Demographics
NPI:1578646154
Name:OXY PRO INC
Entity Type:Organization
Organization Name:OXY PRO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:DUCHARME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-875-7950
Mailing Address - Street 1:13221 HUGH SEYMOUR LN
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2288
Mailing Address - Country:US
Mailing Address - Phone:228-875-7950
Mailing Address - Fax:228-875-7952
Practice Address - Street 1:13221 HUGH SEYMOUR LN
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2288
Practice Address - Country:US
Practice Address - Phone:228-875-7950
Practice Address - Fax:228-875-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05955 / 11.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07500036Medicaid
4853390001Medicare NSC