Provider Demographics
NPI:1902908114
Name:MED-OX HOME MEDICAL
Entity Type:Organization
Organization Name:MED-OX HOME MEDICAL
Other - Org Name:MARK II ENT., LTD
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-323-5764
Mailing Address - Street 1:4867 URBANA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9503
Mailing Address - Country:US
Mailing Address - Phone:937-323-5764
Mailing Address - Fax:937-323-2699
Practice Address - Street 1:95 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2616
Practice Address - Country:US
Practice Address - Phone:740-772-5764
Practice Address - Fax:740-773-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11065332B00000X
OHHMEL11065332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2742803Medicaid
OH1234860004Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER