Provider Demographics
NPI:1326025669
Name:NORTHWEST RESPIRATORY SERVICES, LLC
Entity Type:Organization
Organization Name:NORTHWEST RESPIRATORY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-603-8720
Mailing Address - Street 1:1243 EAGAN INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1232
Mailing Address - Country:US
Mailing Address - Phone:651-603-8720
Mailing Address - Fax:866-296-7913
Practice Address - Street 1:1243 EAGAN INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1232
Practice Address - Country:US
Practice Address - Phone:651-603-8720
Practice Address - Fax:866-296-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41611800Medicaid
NE10025028700Medicaid
IA0234328Medicaid
MN861819400Medicaid
ND51394Medicaid
COPENDINGMedicaid
SD9166883Medicaid