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Organization
SOUTHERN RESPIRATORY, INC
Active
Organization
SOUTHERN RESPIRATORY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HAL CHESTNUT (PRESIDENT)
(352) 385-9116
Entity
Organization
Contact information
Practice address
724 S ROSSITER ST, MOUNT DORA, FL 32757-6139
(352) 385-9116
(352) 385-3729
Mailing address
724 S ROSSITER ST, MOUNT DORA, FL 32757-6139
(352) 385-9116
(352) 385-3729
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
10D2060012
FL
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025848200
—
FL
01
—
R9397
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/20/2006
Last updated
09/23/2013
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