Provider Demographics
NPI:1588678221
Name:SPECIAL CARE HOME OXYGEN AND MEDICAL
Entity Type:Organization
Organization Name:SPECIAL CARE HOME OXYGEN AND MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-644-2273
Mailing Address - Street 1:PO BOX 852437
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75085-2437
Mailing Address - Country:US
Mailing Address - Phone:972-644-2273
Mailing Address - Fax:972-783-0848
Practice Address - Street 1:1301 N PLANO RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2426
Practice Address - Country:US
Practice Address - Phone:972-644-2273
Practice Address - Fax:972-783-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
516416OtherBCBS TX
0591730001Medicare ID - Type Unspecified