Provider Demographics
NPI:1386646511
Name:FAMILY RESPIRATORY SERVICES LLC
Entity Type:Organization
Organization Name:FAMILY RESPIRATORY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-626-6451
Mailing Address - Street 1:411 BLUE TOP RD
Mailing Address - Street 2:STE 3
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-3118
Mailing Address - Country:US
Mailing Address - Phone:423-626-6451
Mailing Address - Fax:
Practice Address - Street 1:411 BLUE TOP RD
Practice Address - Street 2:STE 3
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3118
Practice Address - Country:US
Practice Address - Phone:423-626-6451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN800332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4076834OtherB C/BS
KY9008152Medicaid
TN1454489Medicaid
VA010099269Medicaid
TN5045820001Medicare NSC