Healthcare Provider Details

I. General information

NPI: 1144349655
Provider Name (Legal Business Name): PULMONARY AND CRITICAL SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S TAFT AVE SUITE 188
FREMONT OH
43420
US

IV. Provider business mailing address

1661 HOLLAND RD SUITE 200
MAUMEE OH
43537-4207
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-7800
  • Fax: 419-843-3444
Mailing address:
  • Phone: 419-843-7800
  • Fax: 419-843-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: IRENE JACOB
Title or Position: MANAGER
Credential:
Phone: 419-794-1330