Provider Demographics
NPI:1730330978
Name:OXYGEN PLUS, CORP
Entity type:Organization
Organization Name:OXYGEN PLUS, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:CISSY
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:615-416-1510
Mailing Address - Street 1:900 MCARTHUR STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355
Mailing Address - Country:US
Mailing Address - Phone:931-728-4010
Mailing Address - Fax:931-728-0089
Practice Address - Street 1:2150 WILMA RUDOLPH BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6675
Practice Address - Country:US
Practice Address - Phone:931-552-2690
Practice Address - Fax:931-552-3394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00743332BP3500X
TN106910332BC3200X
TN332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10074830OtherAMERIGROUP
TN1454268Medicaid
TNA3735500OtherAMERICHOICE
TN4057101OtherBCBS
TN4057101OtherBCBS