Basic Information
| Provider Information | |||||||||
| NPI: | 1982839015 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHPORT PULMONARY MEDICINE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1517 N HOWE ST | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | SOUTHPORT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284612772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104579684 | ||||||||
| FaxNumber: | 9104574803 | ||||||||
| Practice Location | |||||||||
| Address1: | 1517 N HOWE ST | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | SOUTHPORT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284612772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104579684 | ||||||||
| FaxNumber: | 9104574803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2009 | ||||||||
| LastUpdateDate: | 06/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | SCHNEYER | ||||||||
| AuthorizedOfficialFirstName: | BARTON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9104579684 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.