Healthcare Provider Details

I. General information

NPI: 1619734670
Provider Name (Legal Business Name): INTERVENTIONAL & PULMONARY CRITICAL CARE ASSOCIATES OF CE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

IV. Provider business mailing address

286 W PAULINE DR
CLEARFIELD PA
16830-1003
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-3770
  • Fax:
Mailing address:
  • Phone: 412-310-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SANDEEP BANSAL
Title or Position: MD
Credential: MD
Phone: 814-375-3770