Provider Demographics
NPI:1063593804
Name:QUALITY HOME OXYGEN, INC.
Entity type:Organization
Organization Name:QUALITY HOME OXYGEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-684-8923
Mailing Address - Street 1:145 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-3215
Mailing Address - Country:US
Mailing Address - Phone:985-386-4760
Mailing Address - Fax:985-386-4761
Practice Address - Street 1:228 STATE ST
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3939
Practice Address - Country:US
Practice Address - Phone:601-684-9386
Practice Address - Fax:601-684-1055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUALITY HOME OXYGEN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-18
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS02453-11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440119Medicaid
LA1981915Medicaid
MS=========OtherUNITED HEALTHCARE
MS=========OtherBLUE CROSS BLUE SHIELD
MS00440119Medicaid
LA1981915Medicaid
MS0597390005Medicare NSC
MS=========OtherBLUE CROSS BLUE SHIELD