Provider Demographics
NPI:1285808071
Name:SPECIALIZED PULSE OXIMETRY TESTING SERVICE, LLC
Entity type:Organization
Organization Name:SPECIALIZED PULSE OXIMETRY TESTING SERVICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KOLLHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, CPFT
Authorized Official - Phone:937-433-7768
Mailing Address - Street 1:1436 YANKEE PARK PL # K
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1899
Mailing Address - Country:US
Mailing Address - Phone:937-433-7768
Mailing Address - Fax:937-433-7722
Practice Address - Street 1:1436 YANKEE PARK PL # K
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1899
Practice Address - Country:US
Practice Address - Phone:937-433-7768
Practice Address - Fax:937-433-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory