Basic Information
| Provider Information | |||||||||
| NPI: | 1407943624 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHEST AND CRITICAL CARE CONSULTANTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 N TUSTIN AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148366800 | ||||||||
| FaxNumber: | 7148369966 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 N TUSTIN AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148366800 | ||||||||
| FaxNumber: | 7148369966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2006 | ||||||||
| LastUpdateDate: | 10/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | GOGIA | ||||||||
| AuthorizedOfficialFirstName: | HARMOHINDER | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | SR MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7147728282 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHEST AND CRITICAL CARE CONSULTANTS | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 208M00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 207RP1001X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | GR0025652 | 05 | CA | MEDICAID |