1245350388 NPI number — VASCULAR & ENDOVASCULAR SURGICAL CONSULTANTS OF ORLANDO PA

Table of content: (NPI 1245350388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245350388 NPI number — VASCULAR & ENDOVASCULAR SURGICAL CONSULTANTS OF ORLANDO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR & ENDOVASCULAR SURGICAL CONSULTANTS OF ORLANDO PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245350388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 690998
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32869-0998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-363-7760
Provider Business Mailing Address Fax Number:
407-363-7473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7412 DOCS GROVE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32819-8010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-363-7760
Provider Business Practice Location Address Fax Number:
407-363-7473
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GARNETTE
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-363-7760

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  ME90094 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7519622 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 273603900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37459 . This is a "MEDICARE ID TYPE UNSPECIFIED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 46022 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 005918700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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