Provider Demographics
NPI:1184748519
Name:MECKLENBURG PULMONARY SPECIALISTS, PLLC
Entity type:Organization
Organization Name:MECKLENBURG PULMONARY SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-926-5469
Mailing Address - Street 1:2711 RANDOLPH RD
Mailing Address - Street 2:STE 208
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2034
Mailing Address - Country:US
Mailing Address - Phone:704-926-5433
Mailing Address - Fax:704-926-5460
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:STE 208
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2034
Practice Address - Country:US
Practice Address - Phone:704-926-5433
Practice Address - Fax:704-926-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400640174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8977165Medicaid
NCF31098Medicare UPIN
NC2199937MMedicare ID - Type Unspecified