Provider Demographics
NPI:1760678676
Name:PEDRO G MENDOZA MD PC
Entity Type:Organization
Organization Name:PEDRO G MENDOZA MD PC
Other - Org Name:PNEUMOS LUNG AND SLEEP SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CODING/BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZASTOUPIL
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:701-323-9900
Mailing Address - Street 1:300 W CENTURY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1401
Mailing Address - Country:US
Mailing Address - Phone:701-323-9900
Mailing Address - Fax:701-323-9911
Practice Address - Street 1:300 W CENTURY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1401
Practice Address - Country:US
Practice Address - Phone:701-323-9900
Practice Address - Fax:701-323-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5553261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND711202Medicare PIN
NDN711202Medicare PIN
ND22774Medicare UPIN
NDN22774Medicare UPIN