Provider Demographics
NPI:1740491315
Name:LUNGCENTER, INC.
Entity type:Organization
Organization Name:LUNGCENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:SALUDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-843-5041
Mailing Address - Street 1:PO BOX 6244
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0722
Mailing Address - Country:US
Mailing Address - Phone:304-843-5041
Mailing Address - Fax:304-845-4586
Practice Address - Street 1:426 8TH ST
Practice Address - Street 2:ROOM 305
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1451
Practice Address - Country:US
Practice Address - Phone:304-843-5041
Practice Address - Fax:304-845-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18009207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0076373000Medicaid
OH0941020Medicaid
WV9345582OtherMEDICARE ID
OH9345581OtherMEDICARE ID
OH0941020Medicaid