Provider Demographics
NPI:1720108442
Name:PULMONARY SPECIALIST GROUP OF NEVADA
Entity Type:Organization
Organization Name:PULMONARY SPECIALIST GROUP OF NEVADA
Other - Org Name:THE LUNG CENTER OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BALDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-737-5864
Mailing Address - Street 1:9280 W SUNSET RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4860
Mailing Address - Country:US
Mailing Address - Phone:702-737-5864
Mailing Address - Fax:702-737-6885
Practice Address - Street 1:9280 W SUNSET RD
Practice Address - Street 2:SUITE 312
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4860
Practice Address - Country:US
Practice Address - Phone:702-737-5864
Practice Address - Fax:702-737-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVWCGZGMedicare Oscar/Certification