1548409428 NPI number — RESPIRA MEDICAL, LP

Table of content: (NPI 1548409428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548409428 NPI number — RESPIRA MEDICAL, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESPIRA MEDICAL, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548409428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1502 HOUSTON ST
Provider Second Line Business Mailing Address:
SUITE100
Provider Business Mailing Address City Name:
GRAND PRAIRIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75050-5200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-695-6900
Provider Business Mailing Address Fax Number:
817-695-6901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 COMMANDER DR
Provider Second Line Business Practice Location Address:
STE 7-8
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75605-4670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-753-9961
Provider Business Practice Location Address Fax Number:
903-753-9976
Provider Enumeration Date:
02/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HORNYAK
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-695-6900

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0081452 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X , with the licence number: 1000043 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7824752 . This is a "AETNA PRIVATE INSURANCE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 204449702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 533213 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 147875 . This is a "SUPERIOR HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 204449701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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