Provider Demographics
NPI:1457442907
Name:MEDICAL WEST RESPIRATORY SERVICES, LLC
Entity Type:Organization
Organization Name:MEDICAL WEST RESPIRATORY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:LANE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:314-993-8100
Mailing Address - Street 1:9301 DIELMAN INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2204
Mailing Address - Country:US
Mailing Address - Phone:314-993-8100
Mailing Address - Fax:
Practice Address - Street 1:1447 US HIGHWAY 61
Practice Address - Street 2:SUITE C
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019
Practice Address - Country:US
Practice Address - Phone:636-937-7448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO18411550332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1616644634MEDOtherMERCY HEALTH PLAN
MO612829OtherHEALTHLINK
MO1024042OtherANCILLARY CARE MGT
MO181658OtherBLUECROSS BLUE SHIELD MO
MO1024042OtherANCILLARY CARE MGT