Provider Demographics
NPI:1124141346
Name:PULMONARY & CRITICAL CARE ASSOCIATES, PC
Entity type:Organization
Organization Name:PULMONARY & CRITICAL CARE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:KOSCIELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-246-9350
Mailing Address - Street 1:621 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 512
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1074
Mailing Address - Country:US
Mailing Address - Phone:574-246-9350
Mailing Address - Fax:574-246-9370
Practice Address - Street 1:621 MEMORIAL DRIVE
Practice Address - Street 2:SUITE 512
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1074
Practice Address - Country:US
Practice Address - Phone:574-246-9350
Practice Address - Fax:574-246-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038686174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDB0360OtherRAILROAD MEDICARE
IN200237190AMedicaid
INDB0360OtherRAILROAD MEDICARE