Provider Demographics
NPI:1568472652
Name:EAST PASCO PULMONARY & CRITICAL CARE ASSOCIATES INC
Entity Type:Organization
Organization Name:EAST PASCO PULMONARY & CRITICAL CARE ASSOCIATES INC
Other - Org Name:PAUL CHAKOLA MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARLENY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-782-4560
Mailing Address - Street 1:38152 MEDICAL CENTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540
Mailing Address - Country:US
Mailing Address - Phone:813-782-4560
Mailing Address - Fax:813-788-9202
Practice Address - Street 1:38152 MEDICAL CENTER AVENUE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540
Practice Address - Country:US
Practice Address - Phone:813-782-4560
Practice Address - Fax:813-788-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42585207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51194OtherBSBC
FLDC9749OtherRAILROAD PROV.#
FL003215900Medicaid
FLK6715Medicare PIN