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General NPI Number Information
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NPI Number | 1609993054
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Entity Type | Organization
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Legal Business Name | PULMONARY SERVICES LLC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3100 MACCORKLE AVE SE STE 805
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City | CHARLESTON
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State | WV
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Zip | 25304-1223
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Country | US
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Telephone | 304-346-0311
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Fax | 304-346-5535
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Provider Business Mailing Address
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Address Line | 3100 MACCORKLE AVE SE STE 805
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City | CHARLESTON
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State | WV
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Zip | 25304-1223
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Country | US
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Telephone | 304-346-0311
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Fax | 304-346-5535
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Authorized Official
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Title or Position | BILLING
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Name | YOLANDA KIDD
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Credential |
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Telephone | 304-346-0311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 16919
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License Number State | WV
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