Provider Demographics
NPI:1518075092
Name:PRINCETON PULMONARY GROUP, P.C.
Entity Type:Organization
Organization Name:PRINCETON PULMONARY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-788-5533
Mailing Address - Street 1:817 PRINCETON AVE SW
Mailing Address - Street 2:STE 115
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1333
Mailing Address - Country:US
Mailing Address - Phone:205-780-1963
Mailing Address - Fax:205-780-2345
Practice Address - Street 1:817 PRINCETON AVE SW
Practice Address - Street 2:STE 115
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1333
Practice Address - Country:US
Practice Address - Phone:205-780-1963
Practice Address - Fax:205-780-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2007-11-21
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
ALCL1358OtherRAILROAD MEDICARE GROUP #
ALCM7930OtherRAILROAD MEDICARE GROUP #
ALG931Medicare PIN
ALCM7930OtherRAILROAD MEDICARE GROUP #