Provider Demographics
NPI:1770624769
Name:QUALIFYING RESPIRATORY SERVICES
Entity type:Organization
Organization Name:QUALIFYING RESPIRATORY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ORLAND
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:940-497-3078
Mailing Address - Street 1:PO BOX 1507
Mailing Address - Street 2:
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065-1507
Mailing Address - Country:US
Mailing Address - Phone:940-497-3078
Mailing Address - Fax:940-497-3079
Practice Address - Street 1:2002 S STEMMONS FWY
Practice Address - Street 2:STE 305
Practice Address - City:LAKE DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75065-3632
Practice Address - Country:US
Practice Address - Phone:940-497-3078
Practice Address - Fax:940-497-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58883227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN
TXFTP015Medicare PIN