Provider Demographics
NPI:1235117276
Name:EASTERN OHIO PULMONARY CONSULTANTS INC
Entity type:Organization
Organization Name:EASTERN OHIO PULMONARY CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-726-3357
Mailing Address - Street 1:960 WINDHAM CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5087
Mailing Address - Country:US
Mailing Address - Phone:330-726-3357
Mailing Address - Fax:330-726-1465
Practice Address - Street 1:960 WINDHAM CT
Practice Address - Street 2:SUITE 1
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5087
Practice Address - Country:US
Practice Address - Phone:330-726-3357
Practice Address - Fax:330-726-1465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9928271Medicare PIN