Provider Demographics
NPI:1700074580
Name:OXYGEN PLUS, CORP
Entity Type:Organization
Organization Name:OXYGEN PLUS, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:CISSY
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-320-1011
Mailing Address - Street 1:3529 BRAINERD RD
Mailing Address - Street 2:STE 2
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-2770
Mailing Address - Country:US
Mailing Address - Phone:423-624-4062
Mailing Address - Fax:
Practice Address - Street 1:3529 BRAINERD RD
Practice Address - Street 2:STE 2
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-2770
Practice Address - Country:US
Practice Address - Phone:423-624-4062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OXYGEN PLUS, CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001961332BX2000X
TN38683336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA3735500OtherAMERICHOICE
TN10074830OtherAMERIGROUP
TN4057101OtherBCBS
TN1454268Medicaid