MEDICARE: INDIANA RESPIRATORY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992706881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA RESPIRATORY SERVICES, LLC

Provider Business Mailing Address
First Line	:	17408 TILLER CT
Second Line	:	SUITE 200
City	:	WESTFIELD
State	:	IN
Zip	:	46074-8509
Country	:	US
Telephone Number	:	317-867-3512
Fax Number	:	317-867-3518

Provider Business Practice Location Address
First Line	:	17408 TILLER CT
Second Line	:	SUITE 200
City	:	WESTFIELD
State	:	IN
Zip	:	46074-8509
Country	:	US
Telephone Number	:	317-867-3512
Fax Number	:	317-867-3518

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DANIEL JAMES JOHNSON
Credential	:
Telephone Number	:	317-867-3512

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	06/25/2008

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