Provider Demographics
NPI:1720266257
Name:ALL FLORIDA RESPIRATORY LLC
Entity Type:Organization
Organization Name:ALL FLORIDA RESPIRATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:COOK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MBA/HCM, RPSGT
Authorized Official - Phone:904-486-0767
Mailing Address - Street 1:205 ZEAGLER DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3888
Mailing Address - Country:US
Mailing Address - Phone:386-328-5911
Mailing Address - Fax:386-328-5972
Practice Address - Street 1:1532 KINGSLEY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4538
Practice Address - Country:US
Practice Address - Phone:904-269-1740
Practice Address - Fax:800-621-5694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7830261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic