1104299965 NPI number — RESPIRATORY & SLEEP SOLUTIONS, LLC

Table of content: (NPI 1104299965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104299965 NPI number — RESPIRATORY & SLEEP SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESPIRATORY & SLEEP SOLUTIONS, 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:
1104299965
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2409 DEARBORN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59801-7586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-593-0219
Provider Business Mailing Address Fax Number:
928-634-0972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40727 N BRADON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTHEM
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85086-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-551-0418
Provider Business Practice Location Address Fax Number:
928-634-0972
Provider Enumeration Date:
11/02/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PHILBIN-VULPIS
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-493-0025

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  4034 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , with the licence number: 4034 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 4034 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QI0500X , with the licence number: 4034 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 4034 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X , with the licence number: 4034 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X , with the licence number: 4034 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , with the licence number: 4034 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS1200X , with the licence number: 4034 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QV0200X , with the licence number: 4034 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 4034 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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