Organization
MOUNTAIN AIR OXYGEN SERVICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSANNE L KANEN (OWNER/PRESIDENT)
(719) 589-4112
Entity
Organization
Contact information
Practice address
2415 MULLINS AVE., ALAMOSA, CO 81101-4264
(719) 589-2573
(719) 589-8891
Mailing address
2415 MULLINS AVE., ALAMOSA, CO 81101-4264
(719) 589-2573
(719) 589-8891
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
07150460001
CO
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08000648
—
CO
Enumeration date
06/30/2005
Last updated
12/02/2011
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