=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326473372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHAUN'S RESPIRATORY SOLUTIONS, LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2013
-----------------------------------------------------
Last Update Date | 02/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1006 WESTLAWN DR
-----------------------------------------------------
City | TEXARKANA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75501-4069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-794-4386
-----------------------------------------------------
Fax | 903-793-4389
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6500 SUMMERHILL RD SUITE C
-----------------------------------------------------
City | TEXARKANA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75503-1721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-793-6464
-----------------------------------------------------
Fax | 903-793-6405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHAUN T DIERKSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-794-4386
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------