Provider Demographics
NPI:1275722084
Name:PETERSON OXIMETRY SERVICES, INC.
Entity Type:Organization
Organization Name:PETERSON OXIMETRY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECY
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-461-2824
Mailing Address - Street 1:625 TRIUMPH DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-6022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 TRIUMPH DR
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-6022
Practice Address - Country:US
Practice Address - Phone:208-461-2824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC508278Medicare PIN