Provider Demographics
NPI:1891961751
Name:PULMONARY ASSOCIATES, INCORPORATED
Entity Type:Organization
Organization Name:PULMONARY ASSOCIATES, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:304-257-3744
Mailing Address - Street 1:96 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-0000
Mailing Address - Country:US
Mailing Address - Phone:304-822-5417
Mailing Address - Fax:304-822-5236
Practice Address - Street 1:35 MONROE STREET
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-0000
Practice Address - Country:US
Practice Address - Phone:304-262-8822
Practice Address - Fax:304-262-8823
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PULMONARY ASSOCIATES, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-01
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV012590332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000203849OtherMTN ST BC/BS
WV3810012709Medicaid
WV3810012709Medicaid