Provider Demographics
NPI:1134440944
Name:EASTSIDE OXYGEN AND MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:EASTSIDE OXYGEN AND MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:614-745-7920
Mailing Address - Street 1:4076 DOMAIN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8496
Mailing Address - Country:US
Mailing Address - Phone:614-745-7920
Mailing Address - Fax:
Practice Address - Street 1:4076 DOMAIN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-8496
Practice Address - Country:US
Practice Address - Phone:614-745-7920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies