Healthcare Provider Details

I. General information

NPI: 1770533721
Provider Name (Legal Business Name): HEARTLAND SLEEP AND PULMONARY LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 US HIGHWAY 27 S
SEBRING FL
33870-4920
US

IV. Provider business mailing address

1751 US HIGHWAY 27 S
SEBRING FL
33870-4920
US

V. Phone/Fax

Practice location:
  • Phone: 863-386-1599
  • Fax: 863-386-1699
Mailing address:
  • Phone: 863-386-1599
  • Fax: 863-386-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberHCC6339
License Number StateFL

VIII. Authorized Official

Name: MARK E LUCKENBACH
Title or Position: OWNER
Credential: CRT
Phone: 863-386-1599