Provider Demographics
NPI:1689786279
Name:RESPIRATORY DISEASE CLINIC
Entity type:Organization
Organization Name:RESPIRATORY DISEASE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CULBERTSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:270-442-3647
Mailing Address - Street 1:1920 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7106
Mailing Address - Country:US
Mailing Address - Phone:270-442-3647
Mailing Address - Fax:270-442-3777
Practice Address - Street 1:1920 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7106
Practice Address - Country:US
Practice Address - Phone:270-442-3647
Practice Address - Fax:270-442-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65907578Medicaid
KY65907578Medicaid