Provider Demographics
NPI:1447441308
Name:SOUTHERN ILLINOIS OXYGEN, INC
Entity type:Organization
Organization Name:SOUTHERN ILLINOIS OXYGEN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:618-285-6370
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62931-0382
Mailing Address - Country:US
Mailing Address - Phone:618-285-3511
Mailing Address - Fax:618-285-3597
Practice Address - Street 1:RR 146
Practice Address - Street 2:
Practice Address - City:ROSICLARE
Practice Address - State:IL
Practice Address - Zip Code:62982
Practice Address - Country:US
Practice Address - Phone:618-285-3511
Practice Address - Fax:618-285-3597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL332B00000XOtherPROVIDER TAXONOMY NUMBER
IL0230910001Medicare NSC
IL332B00000XOtherPROVIDER TAXONOMY NUMBER