Provider Demographics
NPI:1013957786
Name:SPECIALTY OXYGEN SERVICES, INC.
Entity Type:Organization
Organization Name:SPECIALTY OXYGEN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DENEISE
Authorized Official - Last Name:STANDEFER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS
Authorized Official - Phone:423-802-5143
Mailing Address - Street 1:P.O. BOX 1480
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379
Mailing Address - Country:US
Mailing Address - Phone:865-531-0281
Mailing Address - Fax:865-531-0283
Practice Address - Street 1:130 PERIMETER PARK ROAD
Practice Address - Street 2:SUITE H & I
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2103
Practice Address - Country:US
Practice Address - Phone:865-531-0281
Practice Address - Fax:865-531-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000855332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4104806OtherDME # FOR BC/BS
TN1454932Medicaid
TN4104806OtherDME # FOR BC/BS