Provider Demographics
NPI:1952566259
Name:RELIABLE OXYGEN
Entity Type:Organization
Organization Name:RELIABLE OXYGEN
Other - Org Name:BROOKHAVEN RELIABLE OXYGEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-833-1040
Mailing Address - Street 1:PO BOX 1493
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654-1493
Mailing Address - Country:US
Mailing Address - Phone:601-587-0422
Mailing Address - Fax:601-587-0423
Practice Address - Street 1:101 S RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-3330
Practice Address - Country:US
Practice Address - Phone:601-833-1040
Practice Address - Fax:601-833-1045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIABLE OXYGEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies