Provider Demographics
NPI:1962494302
Name:RICHLAND PULMONARY AND CRITICAL CARE ASSOCIATES INC
Entity Type:Organization
Organization Name:RICHLAND PULMONARY AND CRITICAL CARE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAIDVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-524-8250
Mailing Address - Street 1:391 GLESSNER AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2107
Mailing Address - Country:US
Mailing Address - Phone:419-524-8250
Mailing Address - Fax:419-524-6164
Practice Address - Street 1:391 GLESSNER AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2107
Practice Address - Country:US
Practice Address - Phone:419-524-8250
Practice Address - Fax:419-524-6164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2196609Medicaid
OH2196609Medicaid