Organization
AFFORDABLE OXYGEN & MEDICAL SUPPLY. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN R DAVIS (PRESIDENT)
(928) 759-0597
Entity
Organization
Contact information
Practice address
377 N MONTEZUMA ST, STE 111, PRESCOTT, AZ 86301-3020
(928) 759-0597
(928) 759-0748
Mailing address
377 N MONTEZUMA ST, STE 111, PRESCOTT, AZ 86301-3020
(928) 759-0597
(928) 759-0748
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
1121070
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
911588
AZ MEDICAID NUMBER
AZ
Enumeration date
02/01/2007
Last updated
02/15/2008
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