Provider Demographics
NPI:1093761611
Name:PULMOCARE RESPIRATORY SERVICES INC
Entity Type:Organization
Organization Name:PULMOCARE RESPIRATORY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:GINGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-777-5000
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-0721
Mailing Address - Country:US
Mailing Address - Phone:909-777-5000
Mailing Address - Fax:909-777-5005
Practice Address - Street 1:760 VIA LATA
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3977
Practice Address - Country:US
Practice Address - Phone:909-777-5000
Practice Address - Fax:909-777-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGRT0000302279H0200X
CA100576332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome HealthGroup - Multi-Specialty
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral NutritionGroup - Multi-Specialty
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02110FMedicaid
CAGRT000030OtherDEPT OF HEALTH SERVICES
CA1291650001Medicare NSC