Basic Information
| Provider Information | |||||||||
| NPI: | 1295183523 | ||||||||
| 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: | 4029330400 | ||||||||
| FaxNumber: | 4029338400 | ||||||||
| Practice Location | |||||||||
| Address1: | 2112 W VISTA ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658075918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029330400 | ||||||||
| FaxNumber: | 4029338400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2016 | ||||||||
| LastUpdateDate: | 05/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | GOODLETT | ||||||||
| AuthorizedOfficialFirstName: | TIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT & COO | ||||||||
| AuthorizedOfficialTelephone: | 4022814443 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TOTAL RESPIRATORY AND REHAB, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.