Provider Demographics
NPI:1497968424
Name:RESPI-TEST INC.
Entity Type:Organization
Organization Name:RESPI-TEST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:BLAINE
Authorized Official - Suffix:
Authorized Official - Credentials:CRT, RCP
Authorized Official - Phone:919-359-9920
Mailing Address - Street 1:11048 CLEVELAND RD
Mailing Address - Street 2:SUITE 101-102
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-8351
Mailing Address - Country:US
Mailing Address - Phone:919-359-9920
Mailing Address - Fax:919-359-2520
Practice Address - Street 1:11048 CLEVELAND RD
Practice Address - Street 2:SUITE 101-102
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-8351
Practice Address - Country:US
Practice Address - Phone:919-359-9920
Practice Address - Fax:919-359-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500533207RP1001X
NCA-41252278P1004X
NCA-33252278P1004X
NCA-26132279P1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No2278P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary DiagnosticsGroup - Multi-Specialty
No2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary DiagnosticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902258Medicaid