Provider Demographics
NPI:1356369052
Name:OXYMED INC
Entity type:Organization
Organization Name:OXYMED INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-820-9391
Mailing Address - Street 1:5742 INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5128
Mailing Address - Country:US
Mailing Address - Phone:260-969-7517
Mailing Address - Fax:260-969-2766
Practice Address - Street 1:5742 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5128
Practice Address - Country:US
Practice Address - Phone:260-969-7517
Practice Address - Fax:260-969-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMER.22297332B00000X
IN69000147A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200340370BMedicaid
IN200340370BMedicaid