Provider Demographics
NPI:1801944491
Name:DESERT RESPIRATORY SERVICE
Entity type:Organization
Organization Name:DESERT RESPIRATORY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-428-6740
Mailing Address - Street 1:3905 RENO HWY STE B
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-2389
Mailing Address - Country:US
Mailing Address - Phone:775-428-6740
Mailing Address - Fax:
Practice Address - Street 1:3905 RENO HWY
Practice Address - Street 2:STE B
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-8378
Practice Address - Country:US
Practice Address - Phone:775-428-6740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207653332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5471580001Medicare ID - Type Unspecified