1326025669 NPI number — NORTHWEST RESPIRATORY SERVICES, LLC

Table of content: (NPI 1326025669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326025669 NPI number — NORTHWEST RESPIRATORY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST RESPIRATORY SERVICES, LLC
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:
1326025669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1243 EAGAN INDUSTRIAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGAN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55121-1232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-603-8720
Provider Business Mailing Address Fax Number:
866-296-7913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1243 EAGAN INDUSTRIAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAGAN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55121-1232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-603-8720
Provider Business Practice Location Address Fax Number:
866-296-7913
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LARSON
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
651-603-8720

Provider Taxonomy Codes

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

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

  • Identifier: 41611800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025028700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0234328 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 861819400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51394 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: PENDING , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9166883 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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