Provider Demographics
NPI:1588660252
Name:OXYGEN, RESPIRATORY & MEDICAL EQUIP, INC
Entity Type:Organization
Organization Name:OXYGEN, RESPIRATORY & MEDICAL EQUIP, INC
Other - Org Name:DIABETIC AND COMFORT SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:C PEDORTHIST
Authorized Official - Phone:218-625-2095
Mailing Address - Street 1:102 E CENTRAL ENTRANCE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-5569
Mailing Address - Country:US
Mailing Address - Phone:218-625-2095
Mailing Address - Fax:218-625-2096
Practice Address - Street 1:102 E CENTRAL ENTRANCE
Practice Address - Street 2:SUITE 4
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-5569
Practice Address - Country:US
Practice Address - Phone:218-625-2095
Practice Address - Fax:218-625-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9584332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN365414100Medicaid
WI41725300Medicaid
MN170641OtherUCARE OF MINNESOTA
MN82-00304OtherMEDICA
MN1049253OtherPREFERRED ONE
MN93649OtherHEALTHPARTNERS
MN57S00DIOtherBLUECROSS BLUESHIELD
MN1049253OtherPREFERRED ONE