Provider Demographics
NPI:1710342308
Name:SOUTHEASTERN HOME OXYGEN SERVICE, INC.
Entity Type:Organization
Organization Name:SOUTHEASTERN HOME OXYGEN SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-327-8993
Mailing Address - Street 1:PO BOX 4358
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31914-0358
Mailing Address - Country:US
Mailing Address - Phone:706-327-8993
Mailing Address - Fax:706-327-0254
Practice Address - Street 1:2310 CRAWFORD RD STE 106
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-3612
Practice Address - Country:US
Practice Address - Phone:334-384-9244
Practice Address - Fax:334-384-9246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL467332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies