Provider Demographics
NPI:1518951409
Name:RESPIRATORY SPECIALISTS OF INDIANA, INC.
Entity type:Organization
Organization Name:RESPIRATORY SPECIALISTS OF INDIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-786-5425
Mailing Address - Street 1:1715 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-2733
Mailing Address - Country:US
Mailing Address - Phone:317-351-2050
Mailing Address - Fax:
Practice Address - Street 1:1715 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-2733
Practice Address - Country:US
Practice Address - Phone:317-351-2050
Practice Address - Fax:317-351-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200424120 AMedicaid
IN200424120 AMedicaid