Healthcare Provider Details

I. General information

NPI: 1144940412
Provider Name (Legal Business Name): ISLAND PULMONARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36/37 DRONNINGENS GADE
ST. THOMAS VI
00802
US

IV. Provider business mailing address

PO BOX 305221
ST THOMAS VI
00803-5221
US

V. Phone/Fax

Practice location:
  • Phone: 727-519-5027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: IMNETT HABTES
Title or Position: MANAGING MEMBER
Credential:
Phone: 727-519-5027