Provider Demographics
NPI:1831162932
Name:OXYCARE PLUS, INC.
Entity type:Organization
Organization Name:OXYCARE PLUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-329-9095
Mailing Address - Street 1:404 WILKINS WISE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1711
Mailing Address - Country:US
Mailing Address - Phone:662-329-9095
Mailing Address - Fax:662-329-8699
Practice Address - Street 1:520 PEGRAM DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6347
Practice Address - Country:US
Practice Address - Phone:662-842-5363
Practice Address - Fax:662-842-5366
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OXYCARE PLUS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-09
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00441006Medicaid
MS05684/11.1OtherBOARD OF PHARMACY
MS00441006Medicaid