1780695973 NPI number — PULMONARY CRITICAL CARE ASSOCIATES, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780695973 NPI number — PULMONARY CRITICAL CARE ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PULMONARY CRITICAL CARE ASSOCIATES, PC
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:
1780695973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1160 VARNUM ST NE
Provider Second Line Business Mailing Address:
SUITE 214
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20017-2107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-526-5491
Provider Business Mailing Address Fax Number:
202-526-5434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1160 VARNUM ST NE
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20017-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-526-5491
Provider Business Practice Location Address Fax Number:
202-526-5434
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POLK
Authorized Official First Name:
OCTAVIUS
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
202-526-5491

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)





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