Provider Demographics
NPI:1124109822
Name:EVANSVILLE PULMONARY ASSOCIATES, INC.
Entity type:Organization
Organization Name:EVANSVILLE PULMONARY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOM
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-402-7420
Mailing Address - Street 1:611 HARRIET ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1781
Mailing Address - Country:US
Mailing Address - Phone:812-423-8182
Mailing Address - Fax:812-421-9481
Practice Address - Street 1:611 HARRIET ST
Practice Address - Street 2:SUITE 504
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1781
Practice Address - Country:US
Practice Address - Phone:812-423-8182
Practice Address - Fax:812-421-9481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN847450Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER