Provider Demographics
NPI:1023561909
Name:PULMONARY AND CRITICAL CARE NETWORK LLC
Entity Type:Organization
Organization Name:PULMONARY AND CRITICAL CARE NETWORK LLC
Other - Org Name:PCCN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YOUSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYYAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-288-3471
Mailing Address - Street 1:1611 N BELT LINE RD
Mailing Address - Street 2:STE C
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-1793
Mailing Address - Country:US
Mailing Address - Phone:972-288-3471
Mailing Address - Fax:972-288-7445
Practice Address - Street 1:1611 N BELT LINE RD
Practice Address - Street 2:STE C
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1793
Practice Address - Country:US
Practice Address - Phone:972-288-3471
Practice Address - Fax:972-288-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WW0000X, 207R00000X, 207RC0000X, 207RC0200X, 207RI0200X, 207RN0300X, 2084N0400X
TXK9004207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047594903Medicaid
TX047594903Medicaid