Organization
PULMONARY DIAGNOSTIC SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY BURKE-GULLETT RRT, RPSGT (OWNER)
(601) 218-6300
Entity
Organization
Contact information
Practice address
114 MONUMENT PL, VICKSBURG, MS 39180-5169
(601) 636-9064
Mailing address
440 DOGWOOD LAKE DR, VICKSBURG, MS 39183-7462
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N/A
NOT REQUIRED AT THIS TIME
MS
Enumeration date
11/12/2012
Last updated
11/12/2012
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