Provider Demographics
NPI:1740381847
Name:ORTEGA PULMONARY ASSOCIATES PA
Entity Type:Organization
Organization Name:ORTEGA PULMONARY ASSOCIATES PA
Other - Org Name:PULMONARY ASSOCIATES OF BAY COUNTY PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-785-1401
Mailing Address - Street 1:2202 STATE AVE
Mailing Address - Street 2:STE.108
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7601
Mailing Address - Country:US
Mailing Address - Phone:850-785-1401
Mailing Address - Fax:850-763-5117
Practice Address - Street 1:2202 STATE AVE
Practice Address - Street 2:STE.108
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7601
Practice Address - Country:US
Practice Address - Phone:850-785-1401
Practice Address - Fax:850-763-5117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060959500Medicaid
FL060959500Medicaid