Basic Information
| Provider Information | |||||||||
| NPI: | 1518075092 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRINCETON PULMONARY GROUP, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 817 PRINCETON AVE SW | ||||||||
| Address2: | STE 115 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352111333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057801963 | ||||||||
| FaxNumber: | 2057802345 | ||||||||
| Practice Location | |||||||||
| Address1: | 817 PRINCETON AVE SW | ||||||||
| Address2: | STE 115 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352111333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057801963 | ||||||||
| FaxNumber: | 2057802345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2006 | ||||||||
| LastUpdateDate: | 11/21/2007 | ||||||||
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| AuthorizedOfficialLastName: | CAGLE | ||||||||
| AuthorizedOfficialFirstName: | MARCHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2057885533 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | CL1358 | 01 | AL | RAILROAD MEDICARE GROUP # | OTHER | CM7930 | 01 | AL | RAILROAD MEDICARE GROUP # | OTHER |