Provider Demographics
NPI:1033535323
Name:PROFESSIONAL RESPIRATORY SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL RESPIRATORY SERVICES
Other - Org Name:PROFESSIONAL RESPIRATORY AND MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:423-954-8901
Mailing Address - Street 1:2180 STEIN DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7247
Mailing Address - Country:US
Mailing Address - Phone:423-284-6142
Mailing Address - Fax:423-954-8901
Practice Address - Street 1:98 N STAR DR STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-5684
Practice Address - Country:US
Practice Address - Phone:731-300-4784
Practice Address - Fax:731-300-4783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN812332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454665Medicaid
4447220001Medicare NSC