Provider Demographics
NPI:1114390846
Name:PULMONARY & SLEEP CLINIC
Entity type:Organization
Organization Name:PULMONARY & SLEEP CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:P
Authorized Official - Last Name:HALLENBORG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-669-7046
Mailing Address - Street 1:2019 E RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8134
Mailing Address - Country:US
Mailing Address - Phone:435-656-1699
Mailing Address - Fax:435-656-1699
Practice Address - Street 1:2019 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8134
Practice Address - Country:US
Practice Address - Phone:435-656-1699
Practice Address - Fax:435-656-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6996337-1205207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000065523Medicare PIN
UTC98780Medicare PIN