Provider Demographics
NPI:1861664328
Name:CENTRAL WYOMING OXYGEN, LLC
Entity Type:Organization
Organization Name:CENTRAL WYOMING OXYGEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MELLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RNC
Authorized Official - Phone:307-334-0177
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:LUSK
Mailing Address - State:WY
Mailing Address - Zip Code:82225-0577
Mailing Address - Country:US
Mailing Address - Phone:307-334-0177
Mailing Address - Fax:307-334-0179
Practice Address - Street 1:340 EAST 'E' STREET
Practice Address - Street 2:SUITE 160
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-0000
Practice Address - Country:US
Practice Address - Phone:307-237-2711
Practice Address - Fax:307-237-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies