Provider Demographics
NPI:1801975701
Name:SOUTHERN RESPIRATORY, LLC.
Entity type:Organization
Organization Name:SOUTHERN RESPIRATORY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHESTNUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-483-5588
Mailing Address - Street 1:PO BOX 872
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32756-0872
Mailing Address - Country:US
Mailing Address - Phone:352-483-5588
Mailing Address - Fax:352-483-5589
Practice Address - Street 1:918 ROLLING ACRES RD
Practice Address - Street 2:#5
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-5027
Practice Address - Country:US
Practice Address - Phone:352-350-2122
Practice Address - Fax:352-350-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies