Provider Demographics
NPI:1922216704
Name:PULMONARY HEALTH GROUP INC.
Entity Type:Organization
Organization Name:PULMONARY HEALTH GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYUDMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-332-4916
Mailing Address - Street 1:9107 E STAR HILL LN
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5404
Mailing Address - Country:US
Mailing Address - Phone:303-332-4916
Mailing Address - Fax:303-799-7366
Practice Address - Street 1:9107 E STAR HILL LN
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5404
Practice Address - Country:US
Practice Address - Phone:303-332-4916
Practice Address - Fax:303-799-7366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42005410000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42530733Medicaid