Healthcare Provider Details

I. General information

NPI: 1861432379
Provider Name (Legal Business Name): PULMONARY & CRITICAL CARE CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S MAIN ST STE 2
DAYTON OH
45409-2643
US

IV. Provider business mailing address

1520 S MAIN ST #2
DAYTON OH
45409-2698
US

V. Phone/Fax

Practice location:
  • Phone: 937-461-5815
  • Fax: 937-461-2896
Mailing address:
  • Phone: 937-461-5815
  • Fax: 937-461-2896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAUNNA HOLBERT
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 937-461-2057