Provider Demographics
NPI:1922714179
Name:PULMONARY CRITICAL CARE PROFESSIONALS
Entity type:Organization
Organization Name:PULMONARY CRITICAL CARE PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHSIN
Authorized Official - Middle Name:
Authorized Official - Last Name:IJAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-900-4174
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:AL
Mailing Address - Zip Code:35142-0468
Mailing Address - Country:US
Mailing Address - Phone:888-212-4243
Mailing Address - Fax:
Practice Address - Street 1:2800 E BROAD ST STE 500
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6416
Practice Address - Country:US
Practice Address - Phone:682-900-4174
Practice Address - Fax:682-900-4175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ7058OtherSTATE LICENSE