Basic Information
| Provider Information | |||||||||
| NPI: | 1245399344 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PULMONARY CRITICAL CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1735 27TH ST | ||||||||
| Address2: | BLDG C SUITE 108 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456622677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403545891 | ||||||||
| FaxNumber: | 7403546774 | ||||||||
| Practice Location | |||||||||
| Address1: | 1735 27TH ST | ||||||||
| Address2: | BLDG C SUITE 108 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456622677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403545891 | ||||||||
| FaxNumber: | 7403546774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SAAB | ||||||||
| AuthorizedOfficialFirstName: | ELIE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7403545891 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 2024900 | 05 | OH | MEDICAID |