Provider Demographics
NPI:1720008063
Name:JAMES DEVANE ANDERSON
Entity Type:Organization
Organization Name:JAMES DEVANE ANDERSON
Other - Org Name:ANDERSONS HOME OXYGEN & SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DEVANE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:334-493-7081
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-0375
Mailing Address - Country:US
Mailing Address - Phone:334-493-7081
Mailing Address - Fax:334-493-1525
Practice Address - Street 1:101 W COVINGTON AVE
Practice Address - Street 2:B
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-2032
Practice Address - Country:US
Practice Address - Phone:334-493-7081
Practice Address - Fax:334-493-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51032703OtherBCBS OF AL
AL009809650Medicaid
AL1162690001Medicare NSC