Provider Demographics
NPI:1508400458
Name:TOTAL RESPIRATORY AND REHAB, INC.
Entity Type:Organization
Organization Name:TOTAL RESPIRATORY AND REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER/ADMIN SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-796-3695
Mailing Address - Street 1:3422 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3211
Mailing Address - Country:US
Mailing Address - Phone:712-796-3695
Mailing Address - Fax:712-796-3694
Practice Address - Street 1:3422 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3211
Practice Address - Country:US
Practice Address - Phone:712-796-3695
Practice Address - Fax:712-796-3694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOTAL RESPIRATORY AND REHAB, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-04
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies