Provider Demographics
NPI:1912987785
Name:PULMONARY ASSOCIATES, PA
Entity Type:Organization
Organization Name:PULMONARY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOSTIC
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:334-305-0400
Mailing Address - Street 1:PO BOX 2266
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-2266
Mailing Address - Country:US
Mailing Address - Phone:334-305-0400
Mailing Address - Fax:334-305-0401
Practice Address - Street 1:1450 ROSS CLARK CIR STE 400
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4770
Practice Address - Country:US
Practice Address - Phone:334-305-0400
Practice Address - Fax:334-305-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054769700Medicaid
AL528902840Medicaid
FL054769700Medicaid
ALD904Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #