MEDICARE: PULMONARY CRITICAL CARE PROFESSIONALS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician
2	207RP1001X	Pulmonary Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q7058	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1922714179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULMONARY CRITICAL CARE PROFESSIONALS

Provider Business Mailing Address
First Line	:	PO BOX 468
Second Line	:
City	:	SHANNON
State	:	AL
Zip	:	35142-0468
Country	:	US
Telephone Number	:	888-212-4243
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 E BROAD ST STE 500
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6416
Country	:	US
Telephone Number	:	682-900-4174
Fax Number	:	682-900-4175

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MOHSIN IJAZ
Credential	:
Telephone Number	:	682-900-4174

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	05/09/2025

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