Provider Demographics
NPI:1659365963
Name:HAZLETON OXYGEN MEDICAL EQUIPMENT INC.
Entity Type:Organization
Organization Name:HAZLETON OXYGEN MEDICAL EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCARCELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-459-4300
Mailing Address - Street 1:1512B N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-9503
Mailing Address - Country:US
Mailing Address - Phone:570-459-4300
Mailing Address - Fax:570-459-2100
Practice Address - Street 1:1512B N CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-9503
Practice Address - Country:US
Practice Address - Phone:570-459-4300
Practice Address - Fax:570-459-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA82373635332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019172170001Medicaid
PA1423015OtherBLUE CROSS BLUE SHIELD
PA4592400001Medicare ID - Type UnspecifiedMEDICARE