Provider Demographics
NPI:1710095567
Name:FLORIDA ADVANCED PULMONARY PA
Entity Type:Organization
Organization Name:FLORIDA ADVANCED PULMONARY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-873-0508
Mailing Address - Street 1:2801 SW COLLEGE ROAD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474
Mailing Address - Country:US
Mailing Address - Phone:352-873-0508
Mailing Address - Fax:352-861-0260
Practice Address - Street 1:2801 SW COLLEGE ROAD
Practice Address - Street 2:SUITE 16
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4447
Practice Address - Country:US
Practice Address - Phone:352-873-0508
Practice Address - Fax:352-861-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063329207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253196800Medicaid
GA290011760OtherRAILROAD MEDICARE
FL41854OtherBLUE CROSS BLUE SHIELD
FL253196800Medicaid