Provider Demographics
NPI:1619008083
Name:GREENVILLE PULMONARY ASSOCIATES,PA
Entity Type:Organization
Organization Name:GREENVILLE PULMONARY ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAN
Authorized Official - Middle Name:PARAYIL
Authorized Official - Last Name:PHILIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-454-9976
Mailing Address - Street 1:4221 RIDGECREST RD
Mailing Address - Street 2:STE 107
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6005
Mailing Address - Country:US
Mailing Address - Phone:903-454-9976
Mailing Address - Fax:903-454-4509
Practice Address - Street 1:4221 RIDGECREST RD
Practice Address - Street 2:STE 107
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6005
Practice Address - Country:US
Practice Address - Phone:903-454-9976
Practice Address - Fax:903-454-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7111207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1616351-01Medicaid
TX00779VMedicare PIN