MEDICARE: VHG TELEMED HOME VISIT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1063275410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VHG TELEMED HOME VISIT LLC

Provider Business Mailing Address
First Line	:	6550 MAIN ST UNIT 1571
Second Line	:
City	:	NEW PRT RCHY
State	:	FL
Zip	:	34656-9763
Country	:	US
Telephone Number	:	727-808-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 MAIN ST UNIT 1571
Second Line	:
City	:	NEW PRT RCHY
State	:	FL
Zip	:	34656-9763
Country	:	US
Telephone Number	:	727-808-4800
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	SHARI ROSENBERG
Credential	:
Telephone Number	:	727-808-5591

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	01/30/2024

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