Provider Demographics
NPI:1619652872
Name:CALVARY HOME OXYGEN AND MEDICAL LLC
Entity Type:Organization
Organization Name:CALVARY HOME OXYGEN AND MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:COLUMBUS
Authorized Official - Last Name:DOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-205-5024
Mailing Address - Street 1:112 ROWE ST STE D
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-5266
Mailing Address - Country:US
Mailing Address - Phone:478-205-5024
Mailing Address - Fax:478-205-5025
Practice Address - Street 1:112 ROWE ST STE D
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-5266
Practice Address - Country:US
Practice Address - Phone:478-595-0861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies