Provider Demographics
NPI:1871663443
Name:PULMONARY AND PRIMARY CARE ASSOCIATES
Entity Type:Organization
Organization Name:PULMONARY AND PRIMARY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:SMOOT
Authorized Official - Suffix:
Authorized Official - Credentials:DO, DABSM,
Authorized Official - Phone:906-776-5845
Mailing Address - Street 1:1711 S STEPHENSON AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3639
Mailing Address - Country:US
Mailing Address - Phone:906-779-7050
Mailing Address - Fax:906-774-3325
Practice Address - Street 1:1711 S STEPHENSON AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3639
Practice Address - Country:US
Practice Address - Phone:906-779-7050
Practice Address - Fax:906-774-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICS006908207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5220016OtherMEDICARE PIN PRIOR 2007
MIP39080001OtherMEDICARE INDIVIDUAL PIN
MI2712724Medicaid
MIOP39080OtherMEDICARE GROUP PIN
MI5220016OtherMEDICARE PIN PRIOR 2007