Provider Demographics
NPI:1407880719
Name:PULMONARY MEDICINE ASSOCIATES MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:PULMONARY MEDICINE ASSOCIATES MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPC, BUSINESS SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EFSTRATIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-679-3524
Mailing Address - Street 1:1300 ETHAN WAY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2211
Mailing Address - Country:US
Mailing Address - Phone:916-482-7623
Mailing Address - Fax:916-679-3563
Practice Address - Street 1:1300 ETHAN WAY
Practice Address - Street 2:SUITE 600
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2211
Practice Address - Country:US
Practice Address - Phone:916-482-7623
Practice Address - Fax:916-679-3563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical CareGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071171Medicaid
CAGR0071170Medicaid
CAGR0071171Medicaid
CAZZZ24612ZMedicare PIN
CAGR0071170Medicaid
CAZZZ24613ZMedicare PIN