Healthcare Provider Details

I. General information

NPI: 1245336072
Provider Name (Legal Business Name): FAYETTE LUNG AND SLEEP CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 EASY ST PROFESSIONAL PLAZA I, SUITE 108
UNIONTOWN PA
15401-3128
US

IV. Provider business mailing address

205 EASY ST PROFESSIONAL PLAZA I, SUITE 108
UNIONTOWN PA
15401-3128
US

V. Phone/Fax

Practice location:
  • Phone: 724-439-1800
  • Fax: 724-439-0799
Mailing address:
  • Phone: 724-439-1800
  • Fax: 724-439-0799

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

VIII. Authorized Official

Name: DR. PIERRE K. EDDE
Title or Position: OWNER
Credential: M.D.
Phone: 723-439-1800