Provider Demographics
NPI:1285986885
Name:TRICITY PULMONARY MEDICINE LLC
Entity type:Organization
Organization Name:TRICITY PULMONARY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GIRISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-612-0133
Mailing Address - Street 1:PO BOX 3113
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3113
Mailing Address - Country:US
Mailing Address - Phone:423-915-1126
Mailing Address - Fax:423-915-0635
Practice Address - Street 1:181 DUNLAP RD
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617-6333
Practice Address - Country:US
Practice Address - Phone:423-323-7112
Practice Address - Fax:423-323-1393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35140207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty