Provider Demographics
NPI:1093993909
Name:MEMORIAL PULMONOLOGY PA
Entity Type:Organization
Organization Name:MEMORIAL PULMONOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANATOLI
Authorized Official - Middle Name:N
Authorized Official - Last Name:KRASKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-325-1200
Mailing Address - Street 1:10837 KATY FWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2207
Mailing Address - Country:US
Mailing Address - Phone:832-325-1200
Mailing Address - Fax:713-984-8260
Practice Address - Street 1:10837 KATY FWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2207
Practice Address - Country:US
Practice Address - Phone:832-325-1200
Practice Address - Fax:713-984-8260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7782207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178025601Medicaid
TX6368100001Medicare NSC
00733ZMedicare PIN
TX178025601Medicaid