Healthcare Provider Details

I. General information

NPI: 1609993054
Provider Name (Legal Business Name): PULMONARY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVE SE STE 805
CHARLESTON WV
25304-1223
US

IV. Provider business mailing address

3100 MACCORKLE AVE SE STE 805
CHARLESTON WV
25304-1223
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-0311
  • Fax: 304-346-5535
Mailing address:
  • Phone: 304-346-0311
  • Fax: 304-346-5535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number16919
License Number StateWV

VIII. Authorized Official

Name: YOLANDA KIDD
Title or Position: BILLING
Credential:
Phone: 304-346-0311