Provider Demographics
NPI:1497851596
Name:PULMONARY AND CRITICAL CARE ASSOCIATES P A
Entity Type:Organization
Organization Name:PULMONARY AND CRITICAL CARE ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/VP
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROTHSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-276-2044
Mailing Address - Street 1:1893 KINGSLEY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4491
Mailing Address - Country:US
Mailing Address - Phone:904-276-2044
Mailing Address - Fax:904-276-2106
Practice Address - Street 1:425 N LEE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1127
Practice Address - Country:US
Practice Address - Phone:904-366-3738
Practice Address - Fax:904-354-3571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4758050002Medicare NSC
FL97727Medicare PIN