Tackitt, Shane M

Tackitt, Shane M is an individual health care provider with primary practice located at 2700 E Broad St , Mansfield TX 76063-5899. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Hospitalist, Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Tackitt, Shane M can be contacted via phone (682) 242-6470.

Contact Information

Primary practice address
2700 E Broad St Mansfield TX 76063-5899
Phone: (682) 242-6470
Fax: (682) 622-2092
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Hospitalist 208M00000X S5274 Texas
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X Washington
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X BP10058725 Texas
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X S5274 Texas
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X S5274 Texas

Profile Details

NPI number 1588035976
LBN Legal business name Tackitt, Shane M
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 12th, 2015
Last updated Jul 1st, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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