Healthcare Provider Details

I. General information

NPI: 1508017385
Provider Name (Legal Business Name): GILA LUNG, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S MARIPOSA ST
PAYSON AZ
85541-5168
US

IV. Provider business mailing address

401 S MARIPOSA ST
PAYSON AZ
85541-5168
US

V. Phone/Fax

Practice location:
  • Phone: 928-472-8339
  • Fax: 928-472-4497
Mailing address:
  • Phone: 928-472-8339
  • Fax: 928-472-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number27506
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number27506
License Number StateAZ

VIII. Authorized Official

Name: DR. SIMRANJIT SINGH GALHOTRA
Title or Position: PRESIDENT
Credential: MD, MBA
Phone: 928-472-8339