Provider Demographics
NPI:1306867676
Name:PULMONARY ASSOCIATES OF THE SOUTHEAST PC
Entity Type:Organization
Organization Name:PULMONARY ASSOCIATES OF THE SOUTHEAST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDRUP
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:205-802-2000
Mailing Address - Street 1:3686 GRANDVIEW PKWY
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3407
Mailing Address - Country:US
Mailing Address - Phone:205-802-2000
Mailing Address - Fax:205-802-2012
Practice Address - Street 1:3686 GRANDVIEW PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3407
Practice Address - Country:US
Practice Address - Phone:205-802-2000
Practice Address - Fax:205-802-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528302380Medicaid
ALC432Medicare ID - Type Unspecified