Healthcare Provider Details

I. General information

NPI: 1699074716
Provider Name (Legal Business Name): BLACKSTONE MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N REO ST STE 250
TAMPA FL
33609-1039
US

IV. Provider business mailing address

4030 HENDERSON BLVD STE 145
TAMPA FL
33629-4940
US

V. Phone/Fax

Practice location:
  • Phone: 813-831-2727
  • Fax: 888-239-4616
Mailing address:
  • Phone: 813-831-2727
  • Fax: 888-239-4616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: VICK TIPNES
Title or Position: CEO
Credential:
Phone: 813-831-2727