Provider Demographics
NPI:1851671689
Name:MID-MO LUNG ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MID-MO LUNG ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMAYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LODHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-815-7118
Mailing Address - Street 1:1801 BROOKFIELD MNR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6246
Mailing Address - Country:US
Mailing Address - Phone:573-815-7118
Mailing Address - Fax:
Practice Address - Street 1:1801 BROOKFIELD MNR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6246
Practice Address - Country:US
Practice Address - Phone:573-815-7118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117893207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500193800Medicaid
H03692Medicare UPIN