Provider Demographics
NPI:1154780427
Name:NIPTAR, LLC
Entity type:Organization
Organization Name:NIPTAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED RESPIRATORY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:GULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:541-401-9166
Mailing Address - Street 1:1405 FILBERT ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-4018
Mailing Address - Country:US
Mailing Address - Phone:541-401-3917
Mailing Address - Fax:
Practice Address - Street 1:1405 FILBERT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-4018
Practice Address - Country:US
Practice Address - Phone:541-401-3917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRT-P-000774227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Single Specialty