Healthcare Provider Details

I. General information

NPI: 1649655598
Provider Name (Legal Business Name): VISUM MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 GULF TO BAY BLVD
CLEARWATER FL
33759-4313
US

IV. Provider business mailing address

3006 GULF TO BAY BLVD
CLEARWATER FL
33759-4313
US

V. Phone/Fax

Practice location:
  • Phone: 727-474-9729
  • Fax: 727-474-9947
Mailing address:
  • Phone: 727-474-9729
  • Fax: 727-474-9947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. ERIC K. GROTEKE
Title or Position: MEMBER
Credential: DC
Phone: 727-474-9729