# ALPHA OXY-MED LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386625457
- **Authorized official:** MR. RUSSELL E CHURCH (OWNER)
- **Authorized official phone:** (928) 367-7415

## Contact information

- **Practice address:** 674 E WHITE MOUNTAIN BLVD, SUITE 3, PINETOP, AZ 85935
- **Practice address phone:** (928) 367-7415
- **Practice address fax:** (928) 367-7416
- **Mailing address:** PO BOX 2529, LAKESIDE, AZ 85929-2529
- **Mailing address phone:** (928) 367-7415
- **Mailing address fax:** (928) 367-7416

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332BX2000X | Oxygen Equipment & Supplies (DME) | 520 | AZ | Yes |

## Other

- **Enumeration date:** 11/07/2005
- **Last updated:** 11/23/2007