Provider Demographics
NPI:1518022300
Name:OXYLIFE RESPIRATORY SOLUTIONS, LLC
Entity type:Organization
Organization Name:OXYLIFE RESPIRATORY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-312-0016
Mailing Address - Street 1:712 W GIBSON AVE
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85228-4104
Mailing Address - Country:US
Mailing Address - Phone:602-670-2912
Mailing Address - Fax:520-723-0953
Practice Address - Street 1:712 W GIBSON AVE
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85228-4104
Practice Address - Country:US
Practice Address - Phone:602-670-2912
Practice Address - Fax:520-723-0953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20138343332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies