Provider Demographics
NPI:1619009321
Name:RESPIRATORY DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:RESPIRATORY DIAGNOSTIC SERVICES
Other - Org Name:PROFESSIONAL PULMONARY SERVICES SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TEOFILO
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:956-683-1552
Mailing Address - Street 1:3145 CENTER POINT DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8433
Mailing Address - Country:US
Mailing Address - Phone:956-683-1552
Mailing Address - Fax:956-683-1554
Practice Address - Street 1:212 W 18TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2804
Practice Address - Country:US
Practice Address - Phone:956-683-1552
Practice Address - Fax:956-683-1554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXX57828291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1829301-01Medicaid
TXFTSP34Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER