Provider Demographics
NPI:1134124340
Name:PULMONARY PHYSICIANS INC
Entity Type:Organization
Organization Name:PULMONARY PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAULIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-452-8844
Mailing Address - Street 1:2600 TUSCARAWAS ST W
Mailing Address - Street 2:STE 100
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4696
Mailing Address - Country:US
Mailing Address - Phone:330-452-8844
Mailing Address - Fax:330-452-7012
Practice Address - Street 1:2600 TUSCARAWAS ST W
Practice Address - Street 2:STE 100
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4696
Practice Address - Country:US
Practice Address - Phone:330-452-8844
Practice Address - Fax:330-452-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047519207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0692273Medicaid
=========029OtherCARESOURCE
=========COtherAULTCARE
=========8C11OtherANTHEM BC/BS
CN5214Medicare PIN
OH9925971Medicare PIN