Provider Demographics
NPI:1679520712
Name:CRITICAL CARE PULMONARY MEDICINE, PC
Entity type:Organization
Organization Name:CRITICAL CARE PULMONARY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:V
Authorized Official - Credentials:
Authorized Official - Phone:269-969-6100
Mailing Address - Street 1:363 FREMONT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3389
Mailing Address - Country:US
Mailing Address - Phone:269-969-6100
Mailing Address - Fax:269-969-6102
Practice Address - Street 1:363 FREMONT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3389
Practice Address - Country:US
Practice Address - Phone:269-969-6100
Practice Address - Fax:269-969-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherEIN
MIOM76510Medicare ID - Type Unspecified