Provider Demographics
NPI:1053593137
Name:PULMOCARE RESPIRATORY SERVICES, INC.
Entity type:Organization
Organization Name:PULMOCARE RESPIRATORY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GINGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-777-5000
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-0721
Mailing Address - Country:US
Mailing Address - Phone:909-777-5000
Mailing Address - Fax:909-777-5005
Practice Address - Street 1:9353 ACTIVITY RD
Practice Address - Street 2:SUITE F
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4412
Practice Address - Country:US
Practice Address - Phone:858-547-9100
Practice Address - Fax:909-777-5005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PULMOCARE RESPIRATORY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-30
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X
CA100577332BX2000X
CA53198332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02110FMedicaid
CADME02110FMedicaid
CA1093761611Medicare NSC