Provider Demographics
NPI:1215005418
Name:PULMONARY & CRITICAL CARE CONSULTANTS OF LOUISVILLE
Entity Type:Organization
Organization Name:PULMONARY & CRITICAL CARE CONSULTANTS OF LOUISVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-552-2955
Mailing Address - Street 1:1455 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-7700
Mailing Address - Country:US
Mailing Address - Phone:502-689-1835
Mailing Address - Fax:
Practice Address - Street 1:1455 CEDAR ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-7700
Practice Address - Country:US
Practice Address - Phone:502-552-2955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26070207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200806860AMedicaid
IL051953OtherSIHO
IN262400OtherMEDICARE
KY2445153000Medicaid
KY5003733Medicaid
KY9184Medicare ID - Type Unspecified
KY5003733Medicaid
IN200806860AMedicaid