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Organization
ALPHA OXY-MED LLC
Active
Organization
ALPHA OXY-MED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL E CHURCH (OWNER)
(928) 367-7415
Entity
Organization
Contact information
Practice address
674 E WHITE MOUNTAIN BLVD, SUITE 3, PINETOP, AZ 85935
(928) 367-7415
(928) 367-7416
Mailing address
PO BOX 2529, LAKESIDE, AZ 85929-2529
(928) 367-7415
(928) 367-7416
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
520
AZ
Other
Enumeration date
11/07/2005
Last updated
11/23/2007
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