Provider Demographics
NPI:1417059783
Name:TRI-STATE RESPIRATORY INC
Entity Type:Organization
Organization Name:TRI-STATE RESPIRATORY INC
Other - Org Name:ANYTHING MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-758-0150
Mailing Address - Street 1:2580 HIGHWAY 95
Mailing Address - Street 2:SUITE 114
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7491
Mailing Address - Country:US
Mailing Address - Phone:928-758-0150
Mailing Address - Fax:928-758-6590
Practice Address - Street 1:2580 HIGHWAY 95
Practice Address - Street 2:SUITE 114
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7491
Practice Address - Country:US
Practice Address - Phone:928-758-0150
Practice Address - Fax:928-758-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5293390001Medicare NSC