Healthcare Provider Details

I. General information

NPI: 1821038084
Provider Name (Legal Business Name): VASCULAR AND THORACIC SURGERY OF CENTRAL FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S KNOWLES AVE SUITE 1
WINTER PARK FL
32789-7009
US

IV. Provider business mailing address

180 S. KNOWLES AVENUE SUITE 1
WINTER PARK FL
32789-7009
US

V. Phone/Fax

Practice location:
  • Phone: 407-628-1300
  • Fax: 407-628-2788
Mailing address:
  • Phone: 407-628-1300
  • Fax: 407-628-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME40876
License Number StateFL

VIII. Authorized Official

Name: MRS. SHERRY C PHIPPS
Title or Position: OFFICE MGR
Credential:
Phone: 407-628-1300