DR. SHANE M TACKITT


Address: 2700 E Broad St, Mansfield, TX 76063-5899
Phone: 6822426470

DR. SHANE M TACKITT (NPI# 1588035976) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1588035976
Entity Type Individual
Full Name DR. SHANE M TACKITT
Credential DO
Practice Address 2700 E Broad St
Mansfield
TX 76063-5899
Mailing Address 2700 E Broad St
Department Internal Medicine
Mansfield
TX 76063-5899
Practice Telephone 6822426470
Practice Fax Number 6826222092
Mailing Telephone 6822426470
Mailing Fax Number 6826222092
Enumeration Date 2015-10-12
Last Update Date 2020-07-01
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207R00000X Internal Medicine S5274 TX Allopathic & Osteopathic Physicians
N 208M00000X Hospitalist S5274 TX Allopathic & Osteopathic Physicians
N 390200000X Student in an Organized Health Care Education/Training Program S5274 TX Student, Health Care
N 390200000X Student in an Organized Health Care Education/Training Program BP10058725 TX Student, Health Care
N 390200000X Student in an Organized Health Care Education/Training Program WA Student, Health Care

Office Location

Street Address 2700 E BROAD ST
City MANSFIELD
State TX
Zip Code 76063-5899

Providers in the same location

NPI Name Taxonomy Address Enumeration
1689629941 Methodist Hospitals of Dallas General Acute Care Hospital 2700 E Broad St, Mansfield, TX 76063-5899 2006-05-24
1609480466 Caine Salazar Specialist/Technologist, Other 2700 E Broad St, Mansfield, TX 76063-5899 2020-08-31
1225568686 Michael Humiston Specialist/Technologist, Other 2700 E Broad St, Mansfield, TX 76063-5899 2017-06-18
1316472947 Kelsey Christine English Emergency Medicine 2700 E Broad St, Mansfield, TX 76063-5899 2017-04-20
1861747115 David Giovanni Minna Internal Medicine 2700 E Broad St, Mansfield, TX 76063-5899 2012-07-23
1518237429 Lonestar Hospital Medicine Associates, Pa Emergency Medicine 2700 E Broad St, Mansfield, TX 76063-5899 2012-01-09
1598041881 Kathy J Thompson Nurse Practitioner 2700 E Broad St, Mansfield, TX 76063-5899 2011-10-31
1528358025 Alan L Blankenship Jr. Emergency Medicine 2700 E Broad St, Mansfield, TX 76063 2011-04-18
1073803938 Hospitalist Partners of Excellence In Mansfield (h.o.p.e), Pa Hospitalist 2700 E Broad St, Mansfield, TX 76063-5899 2011-04-12
1770891343 Emily Forbes Nurse Practitioner 2700 E Broad St, Mansfield, TX 76063-5899 2010-09-17
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1316558349 Lindsey Vandyke, D.o. Pllc Internal Medicine 3150 E Broad Street, Ste 100, Mansfield, TX 76063 2020-08-13
1942819867 Jennifer Que Chau Nguyen Pharmacist 980 U.S. 287 Frontage Rd #287, Mansfield, TX 76063 2020-07-27
1194346890 Ana Maria Gonzalez Dentist 1600 Us Highway 287, Suite 102, Mansfield, TX 76063 2020-05-04
1245869080 Stateserv Medical of Texas, LLC Durable Medical Equipment & Medical Supplies 7941 Rodeo Trail, Mansfield, TX 76063 2020-04-03
1649802232 Mary Puanani Kamai Nurse Practitioner 1301 E. Debbie Lane, Suite 102 #1405, Mansfield, TX 76063 2020-02-11
1770123028 Gladys Vera Nfodzo Nurse Practitioner 901 W. Broad St, Mansfield, TX 76063 2020-01-14
1669011300 Alexa Smith Nurse Practitioner 2800 E Broad St #304, Mansfield, TX 76063 2019-12-28
1477190437 Mel Rockwall LLC Optometrist 1701 East Broad Street, Ste 109, Mansfield, TX 76063 2019-12-09
1376185512 Daniel Max & Marcandrea LLC Optometrist 1701 East Broad St., Ste 109, Mansfield, TX 76063 2019-10-09
1861046385 Lacey Eaton Counselor 805 Killian Dr, Mansfield, TX 76063 2019-08-01
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Taxonomy Information

Taxonomy Code 207R00000X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine

Taxonomy Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1639606353 Maria Lorena Martinez Rojas Internal Medicine 770 Balgreen Dr Fl 1, Mansfield, OH 44906-4106 2017-05-11
1659736957 Vital Healthcare Solutions Internal Medicine 76 Cherry Ridge Dr, Mansfield, PA 16933-8446 2015-12-31
1366857963 Jiaul Ahsan Pllc Internal Medicine 99 Regency Pkwy Ste 305, Mansfield, TX 76063-7820 2014-06-23
1710329040 Questcare Medical Clinics Pllc Internal Medicine 1001 Matlock Rd Ste 101, Mansfield, TX 76063-3443 2013-07-29
1285992602 Masud Habibullah Internal Medicine 17 Evans Cir, Mansfield, MA 02048-1514 2012-04-24
1063730505 Jaremy Emer James Internal Medicine 252 Matlock Road, Suite 130, Mansfield, TX 76063 2010-05-07
1548419120 Keith D Rigsby, Md, Pa Internal Medicine 4105 Greenwood Way, Mansfield, TX 76063-5563 2008-09-18
1164690111 Denise Kay Bruckerhoff Internal Medicine 1788 Highway 157 N Ste 103, Mansfield, TX 76063-3929 2008-02-12
1609053412 Newlands Inpatient Services Internal Medicine 2700 East Broad St., Mansfield, TX 76063 2008-01-23
1669676136 Sneha Patel Internal Medicine 2800 E Broad St Ste 318, Mansfield, TX 76063-6413 2007-06-11
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Competitor

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City MANSFIELD
Zip Code 76063

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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