Provider Demographics
NPI:1063505386
Name:COLUMBUS LUNG PHYSICIANS PLLC
Entity Type:Organization
Organization Name:COLUMBUS LUNG PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-327-8455
Mailing Address - Street 1:425 HOSPITAL DR
Mailing Address - Street 2:SUITE1
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1901
Mailing Address - Country:US
Mailing Address - Phone:662-327-8455
Mailing Address - Fax:662-327-8424
Practice Address - Street 1:425 HOSPITAL DR
Practice Address - Street 2:SUITE1
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1901
Practice Address - Country:US
Practice Address - Phone:662-327-8455
Practice Address - Fax:662-327-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04200209Medicaid
=========OtherTRICARE
MSC03568Medicare ID - Type Unspecified