MEDICARE: PROFESSIONAL PULMONARY SERVICES

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	291U00000X	Clinical Medical Laboratory	X57828	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942309935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL PULMONARY SERVICES

Provider Business Mailing Address
First Line	:	3145 CENTER POINT DR
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-8433
Country	:	US
Telephone Number	:	956-683-1552
Fax Number	:	956-683-1554

Provider Business Practice Location Address
First Line	:	3145 CENTER POINT DR
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-8433
Country	:	US
Telephone Number	:	956-683-1552
Fax Number	:	956-683-1554

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. TEOFILO FLORES
Credential	:	RCP
Telephone Number	:	956-683-1552

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	02/25/2009

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Directions to “PROFESSIONAL PULMONARY SERVICES ” Practice Location

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