Organization Name: | TRISTATE PULMONARY SERVICES |
NPI Number: | 1376817478 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DARYELL CUSHMAN (OWNER) |
Mailing Address: | 836 Tropicana Dr E Cordova |
State: | TN US |
Postal Code: | 380183571 |
Phone Number: | 9012700555 |
Fax Number: | |
NPI Enumeration Date: | 03/07/2012 |
NPI Last Update Date: | 03/07/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 253Z00000X |
License Number: | RRT-450 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Agencies |
Taxonomy Classification: | In Home Supportive Care |
Taxonomy Specialization: | |
Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |