=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386815553
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESPIRATORY SUPPORT SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2008
-----------------------------------------------------
Last Update Date | 02/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 267 PORTAGE TRAIL EXT W
-----------------------------------------------------
City | CUYAHOGA FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44223-3613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-923-0228
-----------------------------------------------------
Fax | 330-923-1020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 267 PORTAGE TRAIL EXT W
-----------------------------------------------------
City | CUYAHOGA FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44223-3613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-923-0228
-----------------------------------------------------
Fax | 330-923-1020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. EARL MUNTEAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-923-0228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------