Provider Demographics
NPI:1295868198
Name:PULMONARY ASSOCIATES OF BRANDON
Entity Type:Organization
Organization Name:PULMONARY ASSOCIATES OF BRANDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-681-4413
Mailing Address - Street 1:4051 UPPER CREEK DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6825
Mailing Address - Country:US
Mailing Address - Phone:813-634-7033
Mailing Address - Fax:813-634-5797
Practice Address - Street 1:4051 UPPER CREEK DR
Practice Address - Street 2:SUITE 106
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6825
Practice Address - Country:US
Practice Address - Phone:813-634-7033
Practice Address - Fax:813-634-5797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID