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LIFEGUARD MEDICAL GROUPLLC NPI 1750795084


NPI Information

NPI: 1750795084
Provider Name: LIFEGUARD MEDICAL GROUP,LLC
Classification: Emergency Medicine - 207P00000X
Entity Type: Organization

CLIA Number: 22D1097315

Address:
72 EASTVILLE AVE
OAK BLUFFS, MA
ZIP 02557
Phone: (508) 696-6863
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LIFEGUARD MEDICAL GROUP,LLC is an emergency medicine in Oak Bluffs, MA. The provider is an emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. LIFEGUARD MEDICAL GROUP,LLC NPI is 1750795084. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

72 EASTVILLE AVE
OAK BLUFFS, MA
ZIP 02557
Phone: (508) 696-6863

The provider's authorized official is Jeffrey Robert Zack .
The authorized official title is Owner and has the following contact phone number (508) 696-6863.

The CLIA number assigned to this NPI record is 22D1097315 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/14/2014 and was last updated on 6/26/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207P00000XEmergency Medicine213570MASSACHUSETTSYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
13093018MEDICAIDMASSACHUSETTS
2H20262MEDICARE UPINMASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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