Provider Demographics
NPI:1548409428
Name:RESPIRA MEDICAL, LP
Entity Type:Organization
Organization Name:RESPIRA MEDICAL, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-695-6900
Mailing Address - Street 1:1502 HOUSTON ST
Mailing Address - Street 2:SUITE100
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5200
Mailing Address - Country:US
Mailing Address - Phone:817-695-6900
Mailing Address - Fax:817-695-6901
Practice Address - Street 1:102 COMMANDER DR
Practice Address - Street 2:STE 7-8
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4670
Practice Address - Country:US
Practice Address - Phone:903-753-9961
Practice Address - Fax:903-753-9976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0081452332B00000X
TX1000043332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7824752OtherAETNA PRIVATE INSURANCE
TX204449702Medicaid
TX533213OtherBLUE CROSS BLUE SHIELD
TX147875OtherSUPERIOR HEALTH
TX204449701Medicaid
TX533213OtherBLUE CROSS BLUE SHIELD
TX204449702Medicaid