Provider Demographics
NPI:1083607352
Name:LUNG SLEEP AND CRITICAL CARE CONSULTANTS, PC
Entity Type:Organization
Organization Name:LUNG SLEEP AND CRITICAL CARE CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ACTIVE,ATTENDING
Authorized Official - Prefix:
Authorized Official - First Name:T
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:BOUDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:747-851-6151
Mailing Address - Street 1:2350 FREEDOM WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-8200
Mailing Address - Country:US
Mailing Address - Phone:717-851-2465
Mailing Address - Fax:717-741-3043
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8200
Practice Address - Country:US
Practice Address - Phone:717-851-2465
Practice Address - Fax:717-741-3043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051542L207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014367640001Other25 MONUMENT RD #/DEACTIVATED AS OF 10/2008
PA1014367640005Medicaid
PA088776Medicare PIN