Provider Demographics
NPI:1245298405
Name:OCALA LUNG & CRITICAL CARE ASSOCATES INC
Entity type:Organization
Organization Name:OCALA LUNG & CRITICAL CARE ASSOCATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:PURUSHOTTAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MITRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-732-5552
Mailing Address - Street 1:1834 SW 1ST AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8101
Mailing Address - Country:US
Mailing Address - Phone:352-732-5552
Mailing Address - Fax:352-732-1131
Practice Address - Street 1:1834 SW 1ST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8101
Practice Address - Country:US
Practice Address - Phone:352-732-5552
Practice Address - Fax:352-732-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38817OtherBC/BS
FLK0749Medicare PIN