Provider Demographics
NPI:1114954294
Name:CARDIO PULMONARY HOME CARE SERVICES, INC.
Entity Type:Organization
Organization Name:CARDIO PULMONARY HOME CARE SERVICES, INC.
Other - Org Name:CREST MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-326-3500
Mailing Address - Street 1:100 OXMOOR BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5983
Mailing Address - Country:US
Mailing Address - Phone:205-326-3500
Mailing Address - Fax:205-326-3501
Practice Address - Street 1:100 OXMOOR BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5983
Practice Address - Country:US
Practice Address - Phone:205-326-3500
Practice Address - Fax:205-326-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL376332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-01912OtherBLUE CROSS PROVIDER NUMBE
AL515-01912OtherBLUE CROSS PROVIDER NUMBE
AL4114150001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER