Provider Demographics
NPI:1477060549
Name:CONSULTANTS IN LUNGS AND CRITICAL CARE LLC
Entity Type:Organization
Organization Name:CONSULTANTS IN LUNGS AND CRITICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:SURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-421-3949
Mailing Address - Street 1:PO BOX 93505
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0114
Mailing Address - Country:US
Mailing Address - Phone:940-627-1435
Mailing Address - Fax:940-627-1453
Practice Address - Street 1:2301 S FM 51 STE 300
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3864
Practice Address - Country:US
Practice Address - Phone:409-627-1435
Practice Address - Fax:940-627-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3759207RC0200X
207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX382928501Medicaid
TX181190303Medicaid
TX8JD305OtherBCBSTX - WCCA