Provider Demographics
NPI:1801083027
Name:JC HOME OXYGEN AND MEDICAL EQUIPMENT LLC
Entity type:Organization
Organization Name:JC HOME OXYGEN AND MEDICAL EQUIPMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER RESPIRATORY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:AIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:740-743-2688
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:OH
Mailing Address - Zip Code:43783
Mailing Address - Country:US
Mailing Address - Phone:740-743-2688
Mailing Address - Fax:740-743-2217
Practice Address - Street 1:108 SOMERSET SQUARE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:OH
Practice Address - Zip Code:43783
Practice Address - Country:US
Practice Address - Phone:740-743-2688
Practice Address - Fax:740-743-2217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
227900000X
OH89059964332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2069881Medicaid
OH2069881Medicaid