Basic Information
| Provider Information | |||||||||
| NPI: | 1275875445 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LINCARE PULMONARY REHAB SERVICES OF OHIO, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19387 US HIGHWAY 19 N | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337643102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274318462 | ||||||||
| FaxNumber: | 8774084602 | ||||||||
| Practice Location | |||||||||
| Address1: | 17800 JEFFERSON PARK RD | ||||||||
| Address2: | STE107 | ||||||||
| City: | MIDDLEBURG HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441303475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7279999999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2013 | ||||||||
| LastUpdateDate: | 12/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | NANNIE | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7275307700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
ID Information
| ID | Type | State | Issuer | Description | H165620 | 01 | OH | MEDICARE PTAN | OTHER |