Healthcare Provider Details

I. General information

NPI: 1508288291
Provider Name (Legal Business Name): PULMONARY & CRITICAL CARE GROUP OF ORANGE COUNTY LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 EUCLID ST
FOUNTAIN VALLEY CA
92708-4004
US

IV. Provider business mailing address

5665 NEW NORTHSIDE DR SUITE 320
ATLANTA GA
30328-5831
US

V. Phone/Fax

Practice location:
  • Phone: 714-966-7200
  • Fax:
Mailing address:
  • Phone: 770-874-5400
  • Fax: 770-874-5483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROGER PAUL MURRAY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 770-874-5400