Provider Demographics
NPI:1740478148
Name:PULMONARY CLINIC OF NORTHWEST
Entity type:Organization
Organization Name:PULMONARY CLINIC OF NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIMAT
Authorized Official - Middle Name:R
Authorized Official - Last Name:SINGLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-955-1012
Mailing Address - Street 1:11720 FM 1960 RD W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3514
Mailing Address - Country:US
Mailing Address - Phone:281-955-1012
Mailing Address - Fax:281-955-1302
Practice Address - Street 1:11720 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3514
Practice Address - Country:US
Practice Address - Phone:281-955-1012
Practice Address - Fax:281-955-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178276501Medicaid
TX00515YMedicare PIN