Provider Demographics
NPI:1225152085
Name:SOUTH COUNTY PULMONARY MEDICINE, INC
Entity Type:Organization
Organization Name:SOUTH COUNTY PULMONARY MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SOUTH COUNTY PULMONARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-789-0774
Mailing Address - Street 1:360 KINGSTOWN ROAD
Mailing Address - Street 2:STE 207
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3239
Mailing Address - Country:US
Mailing Address - Phone:401-789-0774
Mailing Address - Fax:401-789-1355
Practice Address - Street 1:360 KINGSTOWN ROAD
Practice Address - Street 2:STE 207
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3239
Practice Address - Country:US
Practice Address - Phone:401-789-0774
Practice Address - Fax:401-789-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI299020390Medicare PIN