Healthcare Provider Details

I. General information

NPI: 1740491315
Provider Name (Legal Business Name): LUNGCENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 8TH ST ROOM 305
GLEN DALE WV
26038-1451
US

IV. Provider business mailing address

PO BOX 6244
WHEELING WV
26003-0722
US

V. Phone/Fax

Practice location:
  • Phone: 304-843-5041
  • Fax: 304-845-4586
Mailing address:
  • Phone: 304-843-5041
  • Fax: 304-845-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number18009
License Number StateWV

VIII. Authorized Official

Name: MELVIN THEODORE SALUDES
Title or Position: OWNER
Credential: MD
Phone: 304-843-5041