1023388709 NPI number — MIDWEST RESPIRATORY CARE INC

Table of content: PATRICK M KNOWLES MD (NPI 1053313452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023388709 NPI number — MIDWEST RESPIRATORY CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST RESPIRATORY CARE INC
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:
BLAIR MEDICAL SUPPLY AND HOME CARE
Provider Other Organization Name Type Code:
3
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:
1023388709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9931 S 136TH ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68138-3937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-592-2435
Provider Business Mailing Address Fax Number:
402-592-6914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 E 17TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68025-3264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-948-4700
Provider Business Practice Location Address Fax Number:
402-592-6914
Provider Enumeration Date:
01/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DELASHMUTT
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-592-2435

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 93895 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0599704 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09870 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025327700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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