Provider Demographics
NPI:1538184494
Name:OGLES OXYGEN
Entity type:Organization
Organization Name:OGLES OXYGEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:MELLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-527-5970
Mailing Address - Street 1:110 W NORTH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2779
Mailing Address - Country:US
Mailing Address - Phone:864-527-5970
Mailing Address - Fax:864-527-5971
Practice Address - Street 1:12019 N. RADIO STATION ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678
Practice Address - Country:US
Practice Address - Phone:864-886-8626
Practice Address - Fax:864-261-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC65007759332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2699Medicaid
SC1244140002Medicare ID - Type UnspecifiedPROVIDER NUMBER