Provider Demographics
NPI:1821057639
Name:PULMONARY & CRITICAL CARE ASSOCIATES OF THE TRI-CITIES PC
Entity Type:Organization
Organization Name:PULMONARY & CRITICAL CARE ASSOCIATES OF THE TRI-CITIES PC
Other - Org Name:TRI-CITIES MEDICAL SPECIALISTS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROOQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-458-7814
Mailing Address - Street 1:PO BOX 11768
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-0168
Mailing Address - Country:US
Mailing Address - Phone:804-672-4833
Mailing Address - Fax:804-213-9783
Practice Address - Street 1:602 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2621
Practice Address - Country:US
Practice Address - Phone:804-458-7814
Practice Address - Fax:804-458-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACI3965OtherMEDICARE RAILROAD
VACI3965OtherMEDICARE RAILROAD