Provider Demographics
NPI:1780789545
Name:PEDIATRIC RESPIRATORY CARE
Entity type:Organization
Organization Name:PEDIATRIC RESPIRATORY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLUS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRT RCP
Authorized Official - Phone:903-753-9961
Mailing Address - Street 1:102 COMMANDER
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4608
Mailing Address - Country:US
Mailing Address - Phone:903-753-9961
Mailing Address - Fax:903-753-9976
Practice Address - Street 1:102 COMMANDER
Practice Address - Street 2:SUITE 8
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4608
Practice Address - Country:US
Practice Address - Phone:903-753-9961
Practice Address - Fax:903-753-9976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX0031954332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010040601OtherMEDICAID
TX011433201Medicaid
TX519244OtherBCBS
TX0904530001Medicare ID - Type Unspecified