1528297843 NPI number — ADVANCED RESPIRATORY DIAGNOSTIC

Table of content: (NPI 1528297843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528297843 NPI number — ADVANCED RESPIRATORY DIAGNOSTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED RESPIRATORY DIAGNOSTIC
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:
ARDS, LLC
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:
1528297843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
724 S CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE 114
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97501-7851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-773-1554
Provider Business Mailing Address Fax Number:
877-274-8848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
724 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97501-7851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-773-1554
Provider Business Practice Location Address Fax Number:
877-274-8848
Provider Enumeration Date:
07/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ROMERO
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
ERIC
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-773-1554

Provider Taxonomy Codes

  • Taxonomy code: 227900000X , with the licence number:  RT-P-10125607 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com