1679520712 NPI number — CRITICAL CARE PULMONARY MEDICINE, 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 1679520712 NPI number — CRITICAL CARE PULMONARY MEDICINE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRITICAL CARE PULMONARY MEDICINE, 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:
1679520712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
363 FREMONT ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49017-3389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-969-6100
Provider Business Mailing Address Fax Number:
269-969-6102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
363 FREMONT ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49017-3389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-969-6100
Provider Business Practice Location Address Fax Number:
269-969-6102
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
STACY
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
269-969-6100

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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