Provider Demographics
NPI:1114649779
Name:SJC THORACIC SERVICES, LLC
Entity Type:Organization
Organization Name:SJC THORACIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-819-7745
Mailing Address - Street 1:225 CANDLER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6092
Mailing Address - Country:US
Mailing Address - Phone:912-819-5757
Mailing Address - Fax:912-819-5753
Practice Address - Street 1:225 CANDLER DR STE 201
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6092
Practice Address - Country:US
Practice Address - Phone:912-819-5757
Practice Address - Fax:912-819-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty