Provider Demographics
NPI:1447410519
Name:PULMONARY CONSULTANTS AND PRIMARY CARE PHYSICIANS MEDICAL GROUP INC
Entity type:Organization
Organization Name:PULMONARY CONSULTANTS AND PRIMARY CARE PHYSICIANS MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-639-9401
Mailing Address - Street 1:1010 W LA VETA AVE
Mailing Address - Street 2:SUITE 750
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4312
Mailing Address - Country:US
Mailing Address - Phone:714-361-6600
Mailing Address - Fax:714-919-8804
Practice Address - Street 1:1010 W LA VETA AVE
Practice Address - Street 2:SUITE 750
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4304
Practice Address - Country:US
Practice Address - Phone:714-361-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912919804Medicaid
CACG5665OtherRAILROAD MEDICARE GROUP NUMBER
CA1912919804OtherTYPE 2 NPI
CAW1514OtherTYPE 2 PTAN
CAGR0003350Medicaid