MEDICARE: MIDLANDS PULMONARY AND CRITICAL CARE SPECIALISTS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician		SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861863185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDLANDS PULMONARY AND CRITICAL CARE SPECIALISTS, PC

Provider Business Mailing Address
First Line	:	PO BOX 4145
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29622-4145
Country	:	US
Telephone Number	:	864-540-8025
Fax Number	:	864-540-8027

Provider Business Practice Location Address
First Line	:	1214 N FANT ST STE B
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-4822
Country	:	US
Telephone Number	:	864-540-8025
Fax Number	:	864-540-8027

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	CHARLES ARMISTEAD THOMPSON
Credential	:	MD
Telephone Number	:	864-540-8025

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	08/18/2022

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