=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548048424
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUNGS MEDICAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2023
-----------------------------------------------------
Last Update Date | 10/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2057 SE WATERCREST ST
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34984-4768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-629-1739
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2057 SE WATERCREST ST
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34984-4768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-629-1739
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RRT
-----------------------------------------------------
Name | CHRISTIAN SANTANA
-----------------------------------------------------
Credential | RRT
-----------------------------------------------------
Telephone | 954-629-1739
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------