Provider Demographics
NPI:1609966399
Name:PEDIATRIC PULMONARY ASSOCIATES,PC
Entity Type:Organization
Organization Name:PEDIATRIC PULMONARY ASSOCIATES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC PULMONOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEDDENREIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-327-1787
Mailing Address - Street 1:5155 E FARNESS DR
Mailing Address - Street 2:STE. 111A
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2158
Mailing Address - Country:US
Mailing Address - Phone:520-327-1787
Mailing Address - Fax:520-321-9613
Practice Address - Street 1:5155 E FARNESS DR
Practice Address - Street 2:STE. 111A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2158
Practice Address - Country:US
Practice Address - Phone:520-327-1787
Practice Address - Fax:520-321-9613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ337810Medicaid