Provider Demographics
NPI:1417980178
Name:PULMONARY INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:PULMONARY INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-263-2482
Mailing Address - Street 1:1220 E 3900 S STE 2C
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1319
Mailing Address - Country:US
Mailing Address - Phone:801-263-2482
Mailing Address - Fax:801-263-2424
Practice Address - Street 1:1220 E 3900 S STE 2C
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1319
Practice Address - Country:US
Practice Address - Phone:801-263-2482
Practice Address - Fax:801-263-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2012-11-13
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055221OtherPTAN
2294OtherUNIV OF UTAH
DB6972OtherRAILROAD MEDICARE
DB6972OtherRAILROAD MEDICARE