MEDICARE: SOUTHPORT PULMONARY MEDICINE, PLLC

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1982839015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHPORT PULMONARY MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	1517 N HOWE ST
Second Line	:	SUITE 12
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-2772
Country	:	US
Telephone Number	:	910-457-9684
Fax Number	:	910-457-4803

Provider Business Practice Location Address
First Line	:	1517 N HOWE ST
Second Line	:	SUITE 12
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-2772
Country	:	US
Telephone Number	:	910-457-9684
Fax Number	:	910-457-4803

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BARTON SCHNEYER
Credential	:	MC
Telephone Number	:	910-457-9684

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	06/05/2012

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