Provider Demographics
NPI:1376595033
Name:PULMONARY & CRITICAL CARE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:PULMONARY & CRITICAL CARE ASSOCIATES, P.A.
Other - Org Name:ST. PAUL LUNG CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WIPPERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-726-6219
Mailing Address - Street 1:225 SMITH AVE N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2533
Mailing Address - Country:US
Mailing Address - Phone:651-726-9219
Mailing Address - Fax:651-726-6201
Practice Address - Street 1:225 SMITH AVE N
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2533
Practice Address - Country:US
Practice Address - Phone:651-726-6219
Practice Address - Fax:651-726-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN822261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01255Medicare ID - Type Unspecified