Provider Demographics
NPI:1467427195
Name:INNOVATIVE RESPIRATORY AND MEDICAL
Entity Type:Organization
Organization Name:INNOVATIVE RESPIRATORY AND MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-662-9941
Mailing Address - Street 1:7978-B COLEY DAVIS ROAD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2399
Mailing Address - Country:US
Mailing Address - Phone:615-662-9941
Mailing Address - Fax:615-662-4522
Practice Address - Street 1:7978-B COLEY DAVIS ROAD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2399
Practice Address - Country:US
Practice Address - Phone:615-662-9941
Practice Address - Fax:615-662-4522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2220332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2220OtherSTATE LICENSE NUMBER
TN4101933OtherBC/BS OF TENNESSE NUMBER
TN1454914Medicaid
TN1454914Medicaid