Provider Demographics
NPI:1902011786
Name:ALERT RESPIRATORY SERVICES, INC.
Entity Type:Organization
Organization Name:ALERT RESPIRATORY SERVICES, INC.
Other - Org Name:LAKE SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:239-275-9200
Mailing Address - Street 1:3100 DEL PRADO BLVD
Mailing Address - Street 2:STE#308
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7245
Mailing Address - Country:US
Mailing Address - Phone:239-275-9200
Mailing Address - Fax:239-275-9440
Practice Address - Street 1:700 WEST SUGARLAND HIGHWAY
Practice Address - Street 2:STE #7
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3026
Practice Address - Country:US
Practice Address - Phone:863-983-0492
Practice Address - Fax:863-983-6253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL#1309332B00000X, 332B00000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003839700Medicaid
FL0622620006Medicare NSC