Provider Demographics
NPI:1841200847
Name:MEMORIAL PULMONARY & SLEEP CONSULTANTS A MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:MEMORIAL PULMONARY & SLEEP CONSULTANTS A MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-290-8888
Mailing Address - Street 1:701 E 28TH ST STE 318
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2785
Mailing Address - Country:US
Mailing Address - Phone:562-290-8888
Mailing Address - Fax:
Practice Address - Street 1:701 E 28TH ST STE 318
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2785
Practice Address - Country:US
Practice Address - Phone:562-290-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53904207RP1001X, 207PE0005X
CAG28692207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0086880Medicaid
CAW14764Medicare ID - Type UnspecifiedMEDICARE U PIN NUMBER