Provider Demographics
NPI:1790804300
Name:PULMONARY AND CRITICAL SPECIALISTS INC
Entity Type:Organization
Organization Name:PULMONARY AND CRITICAL SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-794-1330
Mailing Address - Street 1:1661 HOLLAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-4207
Mailing Address - Country:US
Mailing Address - Phone:419-843-7800
Mailing Address - Fax:419-843-3444
Practice Address - Street 1:7640 SYLVANIA AVE
Practice Address - Street 2:SUITE N
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560
Practice Address - Country:US
Practice Address - Phone:419-843-7800
Practice Address - Fax:419-843-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2202020Medicaid
OH2202020Medicaid