Provider Demographics
NPI:1174624100
Name:SAULT OXYGEN, INC
Entity type:Organization
Organization Name:SAULT OXYGEN, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-253-1721
Mailing Address - Street 1:PO BOX 642
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-0642
Mailing Address - Country:US
Mailing Address - Phone:715-732-7030
Mailing Address - Fax:715-732-4202
Practice Address - Street 1:11 OGDEN ST
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-2933
Practice Address - Country:US
Practice Address - Phone:715-732-7030
Practice Address - Fax:715-732-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41735900Medicaid
MI4957744Medicaid
WI41735900Medicaid
MI4957744Medicaid