=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619339496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PULMONARY DIAGNOSTIC SPECIALISTS P.L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2016
-----------------------------------------------------
Last Update Date | 04/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4806 W 8TH ST
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-2412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-581-7908
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4806 W 8TH ST
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-2412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-581-7908
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | JOHN J ROBISON
-----------------------------------------------------
Credential | RRT RCP
-----------------------------------------------------
Telephone | 928-581-7908
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 293D00000X
-----------------------------------------------------
Taxonomy Name | Physiological Laboratory
-----------------------------------------------------
License Number | 6151
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------