Basic Information
| Provider Information | |||||||||
| NPI: | 1245291632 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL RESPIRATORY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2180 STEIN DR | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374217219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239548901 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2180 STEIN DR | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374217219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239548901 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 06/30/2011 | ||||||||
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| AuthorizedOfficialLastName: | CRUMP | ||||||||
| AuthorizedOfficialFirstName: | THERESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4236140297 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | 0000001821 | TN | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 1454665 | 05 | TN | MEDICAID | 4086281 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 1230429 | 01 | TN | HEALTHSPRING | OTHER |