Provider Demographics
NPI:1861863185
Name:MIDLANDS PULMONARY AND CRITICAL CARE SPECIALISTS, PC
Entity Type:Organization
Organization Name:MIDLANDS PULMONARY AND CRITICAL CARE SPECIALISTS, PC
Other - Org Name:LUNG AND CRITICAL CARE SPECIALISTS OF ANDERSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ARMISTEAD
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-540-8025
Mailing Address - Street 1:PO BOX 4145
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-4145
Mailing Address - Country:US
Mailing Address - Phone:864-540-8025
Mailing Address - Fax:864-540-8027
Practice Address - Street 1:1214 N FANT ST STE B
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4822
Practice Address - Country:US
Practice Address - Phone:864-540-8025
Practice Address - Fax:864-540-8027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP8573Medicaid
SC7034Medicare UPIN