Provider Demographics
NPI:1598775058
Name:PULMONARY DISEASE CONSULTANTS, INC.
Entity Type:Organization
Organization Name:PULMONARY DISEASE CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:SANDIFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-441-2600
Mailing Address - Street 1:201 FIRST EXECUTIVE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1697
Mailing Address - Country:US
Mailing Address - Phone:636-441-2600
Mailing Address - Fax:636-447-7612
Practice Address - Street 1:201 FIRST EXECUTIVE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1697
Practice Address - Country:US
Practice Address - Phone:636-441-2600
Practice Address - Fax:636-447-7612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODG6036OtherRAILROAD MEDICARE