Provider Demographics
NPI:1477671402
Name:LARAMIE RESPIRATORY SERVICE, LLC
Entity Type:Organization
Organization Name:LARAMIE RESPIRATORY SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CATTLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-755-0765
Mailing Address - Street 1:255 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-3005
Mailing Address - Country:US
Mailing Address - Phone:307-755-0765
Mailing Address - Fax:307-745-3375
Practice Address - Street 1:255 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-3005
Practice Address - Country:US
Practice Address - Phone:307-755-0765
Practice Address - Fax:307-745-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY112057300Medicaid
WY112057300Medicaid