Healthcare Provider Details

I. General information

NPI: 1528080421
Provider Name (Legal Business Name): PULMONARY AND CRITICAL CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8427 PROVIDENCE RD
OOLTEWAH TN
37363-9619
US

IV. Provider business mailing address

PO BOX 128
BELLAIRE TX
77402-0128
US

V. Phone/Fax

Practice location:
  • Phone: 423-499-2712
  • Fax: 281-833-3323
Mailing address:
  • Phone: 281-833-3330
  • Fax: 281-833-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number17160
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number17160
License Number StateTN

VIII. Authorized Official

Name: JOHN P GUNTER
Title or Position: SOLE MEMBER
Credential: MD
Phone: 423-499-2712