Provider Demographics
NPI:1609993054
Name:PULMONARY SERVICES LLC
Entity Type:Organization
Organization Name:PULMONARY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-346-0311
Mailing Address - Street 1:3100 MACCORKLE AVE SE
Mailing Address - Street 2:STE 805
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1223
Mailing Address - Country:US
Mailing Address - Phone:304-346-0311
Mailing Address - Fax:304-346-5535
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:STE 805
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-346-0311
Practice Address - Fax:304-346-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16919174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0075240000Medicaid
WV1629061973OtherPERSONAL NPI
WV16919OtherLICENSE
WVCI4982OtherMEDICARE RAILROAD
WVBA1648027OtherDEA
WV1629061973OtherPERSONAL NPI