Provider Demographics
NPI:1902247083
Name:PERFORMANCE RESPIRATORY, INC.
Entity type:Organization
Organization Name:PERFORMANCE RESPIRATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:O
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-342-7004
Mailing Address - Street 1:2255 HAINES AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-0404
Mailing Address - Country:US
Mailing Address - Phone:605-342-7004
Mailing Address - Fax:605-342-7032
Practice Address - Street 1:2255 HAINES AVE
Practice Address - Street 2:STE 204
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-0404
Practice Address - Country:US
Practice Address - Phone:605-342-7004
Practice Address - Fax:605-342-7032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1902247083Medicaid
SD7056560001Medicare NSC