Provider Demographics
NPI:1154341683
Name:MEDICAL OXYGEN SUPPLY LLC
Entity type:Organization
Organization Name:MEDICAL OXYGEN SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOTSTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:505-835-3882
Mailing Address - Street 1:PO BOX 1306
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-1306
Mailing Address - Country:US
Mailing Address - Phone:505-835-3882
Mailing Address - Fax:505-835-3882
Practice Address - Street 1:105 MANZANARES AVE E
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4212
Practice Address - Country:US
Practice Address - Phone:505-835-1230
Practice Address - Fax:505-835-3882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5060650001Medicare NSC