Provider Demographics
NPI:1629326285
Name:CISCA PULMONARY CRITICAL CARE INC
Entity Type:Organization
Organization Name:CISCA PULMONARY CRITICAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:YEOMANS
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:954-935-4453
Mailing Address - Street 1:1361 13TH AVE S STE 245
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3238
Mailing Address - Country:US
Mailing Address - Phone:904-396-0300
Mailing Address - Fax:904-396-3039
Practice Address - Street 1:1361 13TH AVE S STE 245
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250
Practice Address - Country:US
Practice Address - Phone:904-493-7174
Practice Address - Fax:904-694-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009836500Medicaid
FL2757133-00Medicaid