Provider Demographics
NPI:1447278148
Name:OXYMED INC
Entity type:Organization
Organization Name:OXYMED INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-820-9391
Mailing Address - Street 1:115 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-1246
Mailing Address - Country:US
Mailing Address - Phone:937-587-1145
Mailing Address - Fax:937-587-9236
Practice Address - Street 1:115 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PEEBLES
Practice Address - State:OH
Practice Address - Zip Code:45660-1246
Practice Address - Country:US
Practice Address - Phone:937-587-1145
Practice Address - Fax:937-587-9236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMER.22039332B00000X
OH332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2727866Medicaid
OH1259120001Medicare ID - Type Unspecified