1356394381 NPI number — RESPIRATORY DIAGNOSTICS LLC

Table of content: (NPI 1356394381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356394381 NPI number — RESPIRATORY DIAGNOSTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESPIRATORY DIAGNOSTICS 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:
1356394381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
168 COLUMBIA CLUB DR W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLYTHEWOOD
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29016-9458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-786-1588
Provider Business Mailing Address Fax Number:
888-817-0201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
168 COLUMBIA CLUB DR W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLYTHEWOOD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29016-9458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-786-1588
Provider Business Practice Location Address Fax Number:
888-817-0201
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GALPHIN
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
803-786-1588

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 293D00000X , with the licence number: 42D1050919 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 72100159780 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1396354381 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00246 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0060691 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1356394381 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7001448 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1527148 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200405170A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200750640A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00813310 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: VA , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026155100 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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