=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922714179
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PULMONARY CRITICAL CARE PROFESSIONALS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2023
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 E BROAD ST STE 500
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76063-6416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-900-4174
-----------------------------------------------------
Fax | 682-900-4175
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 468
-----------------------------------------------------
City | SHANNON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35142-0468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-212-4243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MOHSIN IJAZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 682-900-4174
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------