Harbor Oxygen of Traverse City, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

HARBOR OXYGEN OF TRAVERSE CITY, LLC

Practice address

3860 N Long Lake Rd Ste 1
Traverse City, MI 49684-7204

Phone

(231) 946-0550

Fax

(231) 946-0559

NPI assigned

Jun 18, 2005

Last updated

Jun 7, 2024By 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

Sheila Roberson

Title

Cco

Phone

(480) 528-2609

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1119052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717718400000",
    "number": "1922003664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 N LONG LAKE RD STE 1",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847204",
            "telephone_number": "231-946-0550",
            "fax_number": "231-946-0559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3860 N LONG LAKE RD STE 1",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847204",
            "telephone_number": "231-946-0550",
            "fax_number": "231-946-0559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR OXYGEN OF TRAVERSE CITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-18",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A",
        "authorized_official_last_name": "ROBERSON",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "480-528-2609"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "874535440",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marek Hansdorfer, MD, MS
• Kymbra R. Hansen-Duell, LMSW
• Amber Michele Hansen
• Ashley Denise Hansen, PT
• Harbor Care Associates, LLC
• Harborside Dental PLLC (Harborside Dental)
• Bobbi Marie Harding, LMSW-C
• Brittney Michelle Harding
• Thomas Robert Harding, MD
• Harm Reduction Michigan

• Durable Medical Equipment & Medical Supplies in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Durable Medical Equipment & Medical Supplies in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.