1083006969 NPI number — OLYMPIA RESPIRATORY SERVICES, LLC

Table of content: (NPI 1083006969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083006969 NPI number — OLYMPIA RESPIRATORY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLYMPIA 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:
6
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:
1083006969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 W GERMANTOWN PIKE STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH MEETING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19462-1437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 S UNION AVE STE B1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-1907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-507-5683
Provider Business Practice Location Address Fax Number:
253-507-7793
Provider Enumeration Date:
03/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GRIGGS
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
407-206-0040

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  601977628 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 601977628 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9048695 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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