Provider Demographics
NPI:1689625402
Name:AUSTIN OXYMED, LLC
Entity Type:Organization
Organization Name:AUSTIN OXYMED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-691-6100
Mailing Address - Street 1:8204 N LAMAR BLVD
Mailing Address - Street 2:SUITE C17
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5960
Mailing Address - Country:US
Mailing Address - Phone:512-834-8900
Mailing Address - Fax:512-834-8937
Practice Address - Street 1:8204 N LAMAR BLVD
Practice Address - Street 2:SUITE C17
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-5960
Practice Address - Country:US
Practice Address - Phone:512-834-8900
Practice Address - Fax:512-834-8937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36974332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1200690001Medicare ID - Type UnspecifiedMEDICARE