Organization
OXYCARE MEDICAL SUPPLY COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM WIMMERSTEDT (PRESIDENT)
(618) 234-0202
Entity
Organization
Contact information
Practice address
2725 S BELT W, BELLEVILLE, IL 62226-6777
(618) 234-0202
(618) 234-2209
Mailing address
2725 S BELT W, BELLEVILLE, IL 62226-6777
(618) 234-0202
(618) 234-2209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
203000429
IL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
203000429
IL
332BX2000X
Oxygen Equipment & Supplies (DME)
203000429
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08232154
BLUE CROSS BLUE SHIELD
IL
Enumeration date
09/29/2006
Last updated
12/07/2011
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