Provider Demographics
NPI:1053400887
Name:SOUTHERN PULMONARY CENTER, P.A.
Entity type:Organization
Organization Name:SOUTHERN PULMONARY CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-868-3411
Mailing Address - Street 1:PO BOX 1886
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28053-1886
Mailing Address - Country:US
Mailing Address - Phone:704-868-3411
Mailing Address - Fax:704-865-9722
Practice Address - Street 1:900 COX RD
Practice Address - Street 2:STE B
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3460
Practice Address - Country:US
Practice Address - Phone:704-868-3411
Practice Address - Fax:704-865-9722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8930791Medicaid
NC2288385Medicare ID - Type Unspecified
NCG11118Medicare UPIN