Healthcare Provider Details

I. General information

NPI: 1770624769
Provider Name (Legal Business Name): QUALIFYING RESPIRATORY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 S STEMMONS FWY STE 305
LAKE DALLAS TX
75065-3632
US

IV. Provider business mailing address

PO BOX 1507
LAKE DALLAS TX
75065-1507
US

V. Phone/Fax

Practice location:
  • Phone: 940-497-3078
  • Fax: 940-497-3079
Mailing address:
  • Phone: 940-497-3078
  • Fax: 940-497-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number58883
License Number StateTX

VIII. Authorized Official

Name: ORLAND EUGENE WOODARD
Title or Position: OFFICER
Credential: RRT
Phone: 940-497-3078