Liquid Blue Oxygen, Inc

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

8000001243 Issued in PA

Legal business name

LIQUID BLUE OXYGEN, INC

Practice address

482 Donaldson Rd
Kennerdell, PA 16374-1504

Phone

(814) 385-1321

Fax

(814) 385-1319

NPI assigned

Nov 1, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Danielle D Fyock II

Title

President

Phone

(814) 385-1321

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871671396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "482 DONALDSON RD",
            "city": "KENNERDELL",
            "state": "PA",
            "postal_code": "163741504",
            "telephone_number": "814-385-1321",
            "fax_number": "814-385-1319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "482 DONALDSON RD",
            "city": "KENNERDELL",
            "state": "PA",
            "postal_code": "163741504",
            "telephone_number": "814-385-1321",
            "fax_number": "814-385-1319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIQUID BLUE OXYGEN, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FYOCK",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-385-1321",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "PA",
            "license": "8000001243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.