Healthcare Provider Details

I. General information

NPI: 1174818645
Provider Name (Legal Business Name): CAROLINA PULMONARY SOLUTIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 POCOMOKE RD
FRANKLINTON NC
27525
US

IV. Provider business mailing address

699 POCOMOKE RD
FRANKLINTON NC
27525
US

V. Phone/Fax

Practice location:
  • Phone: 919-495-1978
  • Fax:
Mailing address:
  • Phone: 919-495-1978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberA-4266
License Number StateNC

VIII. Authorized Official

Name: MR. JOSHUA CHRISTOPHER P CHRISTOPHER PENDERGRAFT
Title or Position: REGISTERED RESPIRATORY THERAPIST/OW
Credential: RRT,RCP
Phone: 919-495-1978