Provider Demographics
NPI:1700938693
Name:ASSOCIATED MEDICAL & OXYGEN SUPPLY, INC.
Entity Type:Organization
Organization Name:ASSOCIATED MEDICAL & OXYGEN SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DARREL
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-798-6004
Mailing Address - Street 1:8870 YOUREE DR STE 107
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2512
Mailing Address - Country:US
Mailing Address - Phone:318-798-6004
Mailing Address - Fax:318-798-9570
Practice Address - Street 1:8870 YOUREE DR STE 107
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2512
Practice Address - Country:US
Practice Address - Phone:318-798-6004
Practice Address - Fax:318-798-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA090009644332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB7498OtherBCBS DME PROVIDER NUMBER
LA1656381Medicaid
LA1656381Medicaid