Provider Demographics
NPI:1457545923
Name:ANDREA MARIE EWERT
Entity Type:Organization
Organization Name:ANDREA MARIE EWERT
Other - Org Name:HOME OXYGEN COMPANY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EWERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-523-0202
Mailing Address - Street 1:PO BOX 578173
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-8173
Mailing Address - Country:US
Mailing Address - Phone:209-523-0202
Mailing Address - Fax:888-499-0202
Practice Address - Street 1:5039 PENTECOST DR STE C
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9290
Practice Address - Country:US
Practice Address - Phone:209-523-0202
Practice Address - Fax:888-499-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6086960001Medicare NSC