Provider Demographics
NPI:1386700078
Name:SUPERIOR OXYGEN SERVICES
Entity type:Organization
Organization Name:SUPERIOR OXYGEN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCDONNEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-714-0502
Mailing Address - Street 1:912 GAINESVILLE HWY STE C
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1627
Mailing Address - Country:US
Mailing Address - Phone:678-714-0502
Mailing Address - Fax:770-932-0802
Practice Address - Street 1:912 GAINESVILLE HWY STE C
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1627
Practice Address - Country:US
Practice Address - Phone:678-714-0502
Practice Address - Fax:770-932-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00948703AMedicaid
GA00948703AMedicaid
GA00948703AMedicaid