Provider Demographics
NPI:1780663716
Name:SOUTHERN RESPIRATORY SERVICE, LLC
Entity Type:Organization
Organization Name:SOUTHERN RESPIRATORY SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-479-0844
Mailing Address - Street 1:1771 INTERNATIONAL PKWY
Mailing Address - Street 2:SUITE 121
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1897
Mailing Address - Country:US
Mailing Address - Phone:972-479-0844
Mailing Address - Fax:972-479-0413
Practice Address - Street 1:5011 NE CREEK AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7961
Practice Address - Country:US
Practice Address - Phone:918-302-0140
Practice Address - Fax:918-302-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies