Healthcare Provider Details

I. General information

NPI: 1912058850
Provider Name (Legal Business Name): PULMONARY INNOVATION SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S BELL BLVD STE B
CEDAR PARK TX
78613-3854
US

IV. Provider business mailing address

601 S BELL BLVD STE B
CEDAR PARK TX
78613-3854
US

V. Phone/Fax

Practice location:
  • Phone: 512-249-7120
  • Fax:
Mailing address:
  • Phone: 512-249-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0094928
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number0094928
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0094928
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0094928
License Number StateTX

VIII. Authorized Official

Name: O'DELLE ANNETTE HALL
Title or Position: DIRECTOR
Credential: RRT
Phone: 512-249-7120