1659369452 NPI number — PHYSICIANS FOR PULMONARY & CRITICAL CARE CORP

Table of content: (NPI 1659369452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659369452 NPI number — PHYSICIANS FOR PULMONARY & CRITICAL CARE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS FOR PULMONARY & CRITICAL CARE CORP
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:
1659369452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1450 SOM CENTER RD
Provider Second Line Business Mailing Address:
#25
Provider Business Mailing Address City Name:
MAYFIELD HTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44124-2118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-446-1423
Provider Business Mailing Address Fax Number:
440-446-1498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 SOM CENTER RD
Provider Second Line Business Practice Location Address:
#25
Provider Business Practice Location Address City Name:
MAYFIELD HTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44124-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-446-1423
Provider Business Practice Location Address Fax Number:
440-446-1498
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DINGA
Authorized Official First Name:
MARC
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-446-1423

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: 049397 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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