Provider Demographics
NPI:1043206667
Name:BREATHING DISORDERS SERVICES
Entity Type:Organization
Organization Name:BREATHING DISORDERS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-635-0004
Mailing Address - Street 1:PO BOX 269035
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9035
Mailing Address - Country:US
Mailing Address - Phone:405-635-0004
Mailing Address - Fax:405-635-0009
Practice Address - Street 1:4255 N STOCKTON HILL RD
Practice Address - Street 2:SUITE 6
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-2482
Practice Address - Country:US
Practice Address - Phone:928-692-9525
Practice Address - Fax:928-692-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08036925N332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0979990007Medicare NSC