1780150755 NPI number — FAB PULMONARY SOLUTIONS PLLC

Table of content: (NPI 1780150755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780150755 NPI number — FAB PULMONARY SOLUTIONS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAB PULMONARY SOLUTIONS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780150755
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5622 MCCOMMAS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75206-5636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-300-8599
Provider Business Mailing Address Fax Number:
214-614-9184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 GASTON AVE
Provider Second Line Business Practice Location Address:
4TH FLOOR JONSSON BLDG
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75246-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-957-1067
Provider Business Practice Location Address Fax Number:
214-614-9184
Provider Enumeration Date:
10/17/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BRANCACCIO
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-957-1067

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: J8470 . This is a "TEXAS MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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