Lifeguard Medical Group,LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

213570 Issued in MA

Legal business name

LIFEGUARD MEDICAL GROUP,LLC

Practice address

72 Eastville Ave
Oak Bluffs, MA 02557

Phone

(508) 696-6863

NPI assigned

Jun 14, 2014

Last updated

Jun 26, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeffrey Robert Zack, M.D.

Title

Owner

Phone

(508) 696-6863

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403740800000",
    "number": "1750795084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1356",
            "city": "OAK BLUFFS",
            "state": "MA",
            "postal_code": "025571356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 EASTVILLE AVE",
            "city": "OAK BLUFFS",
            "state": "MA",
            "postal_code": "02557",
            "telephone_number": "508-696-6863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEGUARD MEDICAL GROUP,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-14",
        "last_updated": "2014-06-26",
        "status": "A",
        "authorized_official_last_name": "ZACK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-696-6863",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": "213570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3093018",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tania A Laslovich, A.T.C.
• Peter J Laursen, MD
• Michele Lazerow, DC, LIC.AC.
• Michele Denise Leblanc, RN, BSN
• Nancy E Leport, CNM
• Lisa Schroeder Physical Therapy
• Joseph Martin Litwak, MD
• Stephen Wesley London, M.D.
• Jean Curtis Loud, ED.D.
• Emanna Louis, M.A.

• Emergency Medicine Physician in Oak Bluffs, MA
• Providers in Oak Bluffs, MA by specialty
• Emergency Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.