Provider Demographics
NPI:1396759023
Name:LAKE PULMONARY CRITICAL CARE
Entity type:Organization
Organization Name:LAKE PULMONARY CRITICAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-742-4447
Mailing Address - Street 1:1876 NIGHTINGALE LN
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4359
Mailing Address - Country:US
Mailing Address - Phone:352-343-9943
Mailing Address - Fax:352-343-0661
Practice Address - Street 1:1876 NIGHTINGALE LN
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4359
Practice Address - Country:US
Practice Address - Phone:352-343-9943
Practice Address - Fax:352-343-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV3034OtherBCBS OF FLORIDA
FL5933487104OtherTAX ID #
FLV3034OtherBCBS OF FLORIDA