Provider Demographics
NPI:1871850735
Name:RUSTON PULMONARY AND CRITICAL CARE SPECIALIST, L L C
Entity Type:Organization
Organization Name:RUSTON PULMONARY AND CRITICAL CARE SPECIALIST, L L C
Other - Org Name:PULMONARY CLINIC OF NORTH LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-251-8316
Mailing Address - Street 1:1401 EZELL STREET
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-7218
Mailing Address - Country:US
Mailing Address - Phone:318-251-8316
Mailing Address - Fax:318-251-8229
Practice Address - Street 1:1401 EZELL STREET
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-7218
Practice Address - Country:US
Practice Address - Phone:318-251-8316
Practice Address - Fax:318-251-8229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203971207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2118137Medicaid
LA2118137Medicaid