Basic Information
| Provider Information | |||||||||
| NPI: | 1053704841 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOTAL RESPIRATORY AND REHAB, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5950 S 118TH CIR | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681374426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5157274923 | ||||||||
| FaxNumber: | 5157274932 | ||||||||
| Practice Location | |||||||||
| Address1: | 4178 NW URBANDALE DR | ||||||||
| Address2: | |||||||||
| City: | URBANDALE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503227915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029330400 | ||||||||
| FaxNumber: | 4029338400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2015 | ||||||||
| LastUpdateDate: | 06/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | NOVAK | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT AND OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4029330400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TOTAL RESPIRATORY AND REHAB, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.