1396880845 NPI number — LUNG CENTER ASSOCIATES

Table of content: (NPI 1396880845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396880845 NPI number — LUNG CENTER ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUNG CENTER ASSOCIATES
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:
1396880845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4003 WOODLAWN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-439-3165
Provider Business Mailing Address Fax Number:
713-941-4798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4003 WOODLAWN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-439-3165
Provider Business Practice Location Address Fax Number:
713-941-4798
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STEIN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
713-941-0088

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: 035756801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 092223901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com