Provider Demographics
NPI:1124177134
Name:MILLENNIAL CARE HOME OXYGEN AND MEDICAL SERVICES INC
Entity type:Organization
Organization Name:MILLENNIAL CARE HOME OXYGEN AND MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:KURTIS
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:801-686-4471
Mailing Address - Street 1:707 24TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-2580
Mailing Address - Country:US
Mailing Address - Phone:801-627-1175
Mailing Address - Fax:801-627-0770
Practice Address - Street 1:707 24TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2580
Practice Address - Country:US
Practice Address - Phone:801-627-1175
Practice Address - Fax:801-627-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1001210332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5416290001Medicare NSC