Healthcare Provider Details

I. General information

NPI: 1235117276
Provider Name (Legal Business Name): EASTERN OHIO PULMONARY CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 WINDHAM CT SUITE 1
BOARDMAN OH
44512-5087
US

IV. Provider business mailing address

960 WINDHAM CT SUITE 1
BOARDMAN OH
44512-5087
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-3357
  • Fax: 330-726-1465
Mailing address:
  • Phone: 330-726-3357
  • Fax: 330-726-1465

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
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDY KALIC
Title or Position: PRACTICE MANAGER
Credential:
Phone: 330-726-3357