Provider Demographics
NPI:1790853513
Name:CRESCENT CITY RESPIRATORY
Entity Type:Organization
Organization Name:CRESCENT CITY RESPIRATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:BRISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:504-733-5109
Mailing Address - Street 1:1000 RIVERBEND DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:SAINT ROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70087-3021
Mailing Address - Country:US
Mailing Address - Phone:504-733-5109
Mailing Address - Fax:504-733-5298
Practice Address - Street 1:1000 RIVERBEND DR
Practice Address - Street 2:SUITE L
Practice Address - City:SAINT ROSE
Practice Address - State:LA
Practice Address - Zip Code:70087-3021
Practice Address - Country:US
Practice Address - Phone:504-733-5109
Practice Address - Fax:504-733-5298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2677045001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1431541Medicaid
LA1323750001Medicare ID - Type Unspecified