Basic Information
| Provider Information | |||||||||
| NPI: | 1770014771 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DALLAS PULMONARY ASSOCIATES CRITICAL CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 W COLORADO BLVD | ||||||||
| Address2: | STE 845 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752082363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149605681 | ||||||||
| FaxNumber: | 2149472727 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 W COLORADO BLVD | ||||||||
| Address2: | STE 845 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752082363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149605681 | ||||||||
| FaxNumber: | 2149472727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2017 | ||||||||
| LastUpdateDate: | 03/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | BONDOC | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
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| AuthorizedOfficialTitleorPosition: | AGACNP | ||||||||
| AuthorizedOfficialTelephone: | 8177152810 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 207RP1001X | TX | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 319227001 | 05 | TX | MEDICAID |