Provider Demographics
NPI:1992706881
Name:INDIANA RESPIRATORY SERVICES, LLC
Entity type:Organization
Organization Name:INDIANA RESPIRATORY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-867-3512
Mailing Address - Street 1:17408 TILLER CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8509
Mailing Address - Country:US
Mailing Address - Phone:317-867-3512
Mailing Address - Fax:317-867-3518
Practice Address - Street 1:17408 TILLER CT
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8509
Practice Address - Country:US
Practice Address - Phone:317-867-3512
Practice Address - Fax:317-867-3518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200397240AMedicaid
IN6106490001Medicare NSC