Provider Demographics
NPI:1710162524
Name:CENTER FOR PULMONARY AND CRITICAL CARE MEDICINE, PLC
Entity Type:Organization
Organization Name:CENTER FOR PULMONARY AND CRITICAL CARE MEDICINE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNASAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-542-2647
Mailing Address - Street 1:PO BOX 30805
Mailing Address - Street 2:2032 WILMA RUDOLPH BLVD.
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-0014
Mailing Address - Country:US
Mailing Address - Phone:931-542-2647
Mailing Address - Fax:931-542-2648
Practice Address - Street 1:298 CLEAR SKY CT
Practice Address - Street 2:STE. B
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5685
Practice Address - Country:US
Practice Address - Phone:931-542-2647
Practice Address - Fax:931-542-2648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34189207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38521912OtherMEDICARE GROUP/ ORGANIZATION PTAN