Healthcare Provider Details

I. General information

NPI: 1871663443
Provider Name (Legal Business Name): PULMONARY AND PRIMARY CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 S STEPHENSON AVE SUITE 215
IRON MOUNTAIN MI
49801-3639
US

IV. Provider business mailing address

1711 S STEPHENSON AVE SUITE 215
IRON MOUNTAIN MI
49801-3639
US

V. Phone/Fax

Practice location:
  • Phone: 906-779-7050
  • Fax: 906-774-3325
Mailing address:
  • Phone: 906-779-7050
  • Fax: 906-774-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberCS006908
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberCS006908
License Number StateMI

VIII. Authorized Official

Name: DR. CARL ASHLEY SMOOT
Title or Position: PRESIDENT
Credential: D.O, D.A.B.S.M,
Phone: 906-776-5845