Alpha Oxy-Med LLC

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

520 Issued in AZ

Legal business name

ALPHA OXY-MED LLC

Practice address

674 E White Mountain Blvd
Suite 3
Pinetop, AZ 85935

Phone

(928) 367-7415

Fax

(928) 367-7416

NPI assigned

Nov 7, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Russell E Church

Title

Owner

Phone

(928) 367-7415

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195776000000",
    "number": "1386625457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2529",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859292529",
            "telephone_number": "928-367-7415",
            "fax_number": "928-367-7416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "674 E WHITE MOUNTAIN BLVD",
            "address_2": "SUITE 3",
            "city": "PINETOP",
            "state": "AZ",
            "postal_code": "85935",
            "telephone_number": "928-367-7415",
            "fax_number": "928-367-7416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALPHA OXY-MED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-07",
        "last_updated": "2007-11-23",
        "status": "A",
        "authorized_official_last_name": "CHURCH",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-367-7415",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "AZ",
            "license": "520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "853483",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oxygen Equipment & Supplies (DME) in Pinetop, AZ
• Providers in Pinetop, AZ by specialty
• Oxygen Equipment & Supplies (DME) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.