NPIViewer - Provider NPI 1427073246

NPI:	1427073246
Name:	SENIOR RESPIRATORY SOLUTIONS, INC.
Entity type:	Organization
Organization Name:	SENIOR RESPIRATORY SOLUTIONS, INC.
Other - Org Name:	<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:	CEO/BOARD OF DIRECTORS
Authorized Official - Prefix:	MRS
Authorized Official - First Name:	LORI
Authorized Official - Middle Name:	S
Authorized Official - Last Name:	JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	903-794-4386
Mailing Address - Street 1:	3101 KENNEDY LANE
Mailing Address - Street 2:	SUITE 1000
Mailing Address - City:	TEXARKANA
Mailing Address - State:	TX
Mailing Address - Zip Code:	75503-3560
Mailing Address - Country:	US
Mailing Address - Phone:	903-794-4386
Mailing Address - Fax:	903-794-4390
Practice Address - Street 1:	3101 KENNEDY LANE
Practice Address - Street 2:	SUITE 1000
Practice Address - City:	TEXARKANA
Practice Address - State:	TX
Practice Address - Zip Code:	75503-3560
Practice Address - Country:	US
Practice Address - Phone:	903-794-4386
Practice Address - Fax:	903-794-4390
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2006-07-13
Last Update Date:	2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy
No	3336M0002X	Suppliers	Pharmacy	Mail Order Pharmacy

State	Identifier ID	ID Type	Issuer
LA	1270547	Medicaid
IA	1427073246	Medicaid
NV	1427073246	Medicaid
OH	1427073246	Medicaid
RI	4613480	Medicaid
AL	102559	Medicaid
VA	1427073246	Medicaid
AR	149415716	Medicaid
WV	3810014223	Medicaid
MI	4826303	Medicaid
AZ	989890	Medicaid
NH	30765588	Medicaid
	4527668	Other	NCPDP PROVIDER IDENTIFICATION NUMBER
MN	584688200	Medicaid
WA	6031884	Medicaid
AK	PH001TX	Medicaid
TX	157363602	Medicaid
KS	200592340A	Medicaid
MS	4153314	Medicaid
TN	4582406	Medicaid
ID	808239100	Medicaid
VT	1015651	Medicaid
SC	1427073246	Medicaid
IL	1427073246	Medicaid
PA	7824492002	Medicaid
WI	82476600	Medicaid
CT	1427073246	Medicaid
IN	200351090A	Medicaid
OR	270951	Medicaid
ME	433317300	Medicaid
MT	1427073246	Medicaid
OK	200051030B	Medicaid
MO	626203905	Medicaid
ID	808239100	Medicaid