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General NPI Number Information
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NPI Number | 1861991937
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE LUNG CLINIC LLC
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1350 13TH AVE S
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3203
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Country | US
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Telephone | 904-627-2900
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Fax | 904-253-3098
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Provider Business Mailing Address
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Address Line | 7500 RIALTO BLVD
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City | AUSTIN
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State | TX
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Zip | 78735-8531
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Country | US
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Telephone | 512-730-3060
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CHAD PEW
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Credential |
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Telephone | 307-262-9410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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