Provider Demographics
NPI:1619291234
Name:TEQUESTA MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:TEQUESTA MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:ACKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-546-3455
Mailing Address - Street 1:11900 SE FEDERAL HWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-5320
Mailing Address - Country:US
Mailing Address - Phone:772-546-3455
Mailing Address - Fax:
Practice Address - Street 1:11900 SE FEDERAL HWY
Practice Address - Street 2:SUITE 212
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-5320
Practice Address - Country:US
Practice Address - Phone:772-546-3455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty