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General NPI Number Information
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NPI Number | 1447266085
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Entity Type | Organization
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Legal Business Name | PULMONOLOGY AND SLEEP CENTER LLC
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 2300 SOUTH CONGRESS AVENUE SUITE 101
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City | BOYNTON BEACH
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State | FL
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Zip | 33426
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Country | US
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Telephone | 561-374-8911
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Fax | 561-374-8911
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Provider Business Mailing Address
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Address Line | PO BOX 550
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City | BOYNTON BEACH
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State | FL
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Zip | 33425-0550
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Country | US
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Telephone | 561-374-8919
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Fax | 581-374-8911
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | FREDERICK TACKEY
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Credential | MD
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Telephone | 561-374-8919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0068055
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 0068055
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 0068055
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License Number State | FL
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