Provider Demographics
NPI:1912242231
Name:RESPIRATORY DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:RESPIRATORY DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:IMBESE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:918-742-6364
Mailing Address - Street 1:PO BOX 4237
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74159-0237
Mailing Address - Country:US
Mailing Address - Phone:918-742-6364
Mailing Address - Fax:918-742-6364
Practice Address - Street 1:2561 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3120
Practice Address - Country:US
Practice Address - Phone:918-742-6364
Practice Address - Fax:918-742-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory