Provider Demographics
NPI:1346305976
Name:TRI-STATE RESPIRATORY SERVICE INC
Entity Type:Organization
Organization Name:TRI-STATE RESPIRATORY SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:SWEITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-478-9526
Mailing Address - Street 1:PO BOX 4553
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37320-4553
Mailing Address - Country:US
Mailing Address - Phone:423-478-9526
Mailing Address - Fax:423-478-9527
Practice Address - Street 1:60 25TH ST NW
Practice Address - Street 2:SUITE 4
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3871
Practice Address - Country:US
Practice Address - Phone:423-478-9526
Practice Address - Fax:423-478-9527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0000000483332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3542596Medicaid
TN000022219OtherBCBS OF TN
TN0140480001Medicare NSC