Provider Demographics
NPI:1720054695
Name:HOME OXYGEN CARE, INC.
Entity Type:Organization
Organization Name:HOME OXYGEN CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:870-561-8424
Mailing Address - Street 1:PO BOX 1183
Mailing Address - Street 2:
Mailing Address - City:MANILA
Mailing Address - State:AR
Mailing Address - Zip Code:72442-1183
Mailing Address - Country:US
Mailing Address - Phone:870-561-8424
Mailing Address - Fax:870-561-1047
Practice Address - Street 1:621 A. W. HWY 18
Practice Address - Street 2:
Practice Address - City:MANILA
Practice Address - State:AR
Practice Address - Zip Code:72442
Practice Address - Country:US
Practice Address - Phone:870-561-8424
Practice Address - Fax:870-561-1047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139784716Medicaid
MO624011904Medicaid
AR1205070001Medicare NSC