Organization
SPECIALIZED OXYGEN SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY DENEISE STANDEFER RN, BS (PRESIDENT (CO-OWNER))
(423) 847-0031
Entity
Organization
Contact information
Practice address
1008 EXECUTIVE DR, SUITE 102, HIXSON, TN 37343-3991
(423) 847-0031
(423) 847-0525
Mailing address
PO BOX 965, HIXSON, TN 37343-0965
(423) 847-0031
(423) 847-0525
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0000000727
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000974366A
DME PROVIDER # GAMCAID
GA
05
—
1454230
—
TN
01
—
4049414
DME PROVIDER # BC/BS
TN
Enumeration date
05/23/2006
Last updated
10/24/2012
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