MEDICARE: FAMILY 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	800	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4076834	OTHER	TN	B C/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386646511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY RESPIRATORY SERVICES LLC

Provider Business Mailing Address
First Line	:	411 BLUE TOP RD
Second Line	:	STE 3
City	:	TAZEWELL
State	:	TN
Zip	:	37879-3118
Country	:	US
Telephone Number	:	423-626-6451
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 BLUE TOP RD
Second Line	:	STE 3
City	:	TAZEWELL
State	:	TN
Zip	:	37879-3118
Country	:	US
Telephone Number	:	423-626-6451
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LANA ELLISON
Credential	:
Telephone Number	:	423-626-6451

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/01/2012

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