Provider Demographics
NPI:1538259379
Name:SHASTA RESPIRATORY SERVICES
Entity type:Organization
Organization Name:SHASTA RESPIRATORY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:530-474-9361
Mailing Address - Street 1:PO BOX 994032
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-4032
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:530-241-5377
Practice Address - Street 1:28850 SHINGLE CREEK LN
Practice Address - Street 2:
Practice Address - City:SHINGLETOWN
Practice Address - State:CA
Practice Address - Zip Code:96088-9658
Practice Address - Country:US
Practice Address - Phone:530-474-9361
Practice Address - Fax:530-474-9361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000213692278P1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Function TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ31775ZMedicare ID - Type Unspecified
Y36917Medicare UPIN