Healthcare Provider Details

I. General information

NPI: 1538845607
Provider Name (Legal Business Name): PULMCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PENNSYLVANIA AVE
FORT WORTH TX
76104-2228
US

IV. Provider business mailing address

514 TIMBER LAKE DR
SOUTHLAKE TX
76092-7204
US

V. Phone/Fax

Practice location:
  • Phone: 312-731-8335
  • Fax: 682-207-1030
Mailing address:
  • Phone: 817-290-2239
  • Fax: 682-207-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAVANYA SRINIVASAN
Title or Position: OWNER
Credential: MD
Phone: 312-731-8335