Provider Demographics
NPI:1861432379
Name:PULMONARY & CRITICAL CARE CONSULTANTS, INC
Entity type:Organization
Organization Name:PULMONARY & CRITICAL CARE CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-461-2057
Mailing Address - Street 1:1520 S MAIN ST
Mailing Address - Street 2:#2
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2698
Mailing Address - Country:US
Mailing Address - Phone:937-461-5815
Mailing Address - Fax:937-461-2896
Practice Address - Street 1:1520 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2643
Practice Address - Country:US
Practice Address - Phone:937-461-5815
Practice Address - Fax:937-461-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0562707Medicaid
OH0562707Medicaid
OH0562707Medicaid