Provider Demographics
NPI:1578842175
Name:WATERVILLE HOME OXYGEN, LLC
Entity Type:Organization
Organization Name:WATERVILLE HOME OXYGEN, LLC
Other - Org Name:AUGUSTA LOCATION, WATERVILLE HOME OXYGEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:207-872-0500
Mailing Address - Street 1:84 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5604
Mailing Address - Country:US
Mailing Address - Phone:207-872-0500
Mailing Address - Fax:207-872-9500
Practice Address - Street 1:99 BANGOR ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4340
Practice Address - Country:US
Practice Address - Phone:207-624-0911
Practice Address - Fax:207-624-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMGD80001003332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432147900Medicaid