Provider Demographics
NPI:1780877852
Name:OXFORD MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:OXFORD MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KWAKU
Authorized Official - Middle Name:BOAFO
Authorized Official - Last Name:MANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-438-0033
Mailing Address - Street 1:11863 BENHAM RD
Mailing Address - Street 2:SUITE LL
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-1308
Mailing Address - Country:US
Mailing Address - Phone:314-438-0033
Mailing Address - Fax:866-234-0518
Practice Address - Street 1:11863 BENHAM RD
Practice Address - Street 2:SUITE LL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-1308
Practice Address - Country:US
Practice Address - Phone:314-438-0033
Practice Address - Fax:866-234-0518
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OXFORD MEDICAL SUPPLIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-22
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4947120001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4947120001Medicare NSC