Provider Demographics
NPI:1679747752
Name:PULMONARY ASSOCIATES, INC
Entity Type:Organization
Organization Name:PULMONARY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:304-538-3363
Mailing Address - Street 1:433 KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-9474
Mailing Address - Country:US
Mailing Address - Phone:304-538-3363
Mailing Address - Fax:304-538-2483
Practice Address - Street 1:2862 US HIGHWAY 220 S
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-8330
Practice Address - Country:US
Practice Address - Phone:304-538-3363
Practice Address - Fax:304-538-2483
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PULMONARY ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-18
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV012590332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000203849OtherBC/BS
WV0148137000Medicaid
WV0148137000Medicaid