Provider Demographics
NPI:1336205814
Name:SUNSHINE OXYGEN SERVICE INCORPORATED
Entity Type:Organization
Organization Name:SUNSHINE OXYGEN SERVICE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN AND CPA
Authorized Official - Phone:406-549-3980
Mailing Address - Street 1:1104 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-9706
Mailing Address - Country:US
Mailing Address - Phone:406-549-3980
Mailing Address - Fax:
Practice Address - Street 1:1104 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:LOLO
Practice Address - State:MT
Practice Address - Zip Code:59847-9706
Practice Address - Country:US
Practice Address - Phone:406-549-3980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000562965Medicaid
MT0000562965Medicaid