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General NPI Number Information
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NPI Number | 1134738974
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Entity Type | Organization
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Legal Business Name | VMD PRIMARY PROVIDERS CENTRAL FLORIDA PLLC
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 4501 13TH ST
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City | SAINT CLOUD
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State | FL
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Zip | 34769-6742
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Country | US
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Telephone | 407-798-8800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 360262
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City | PITTSBURGH
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State | PA
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Zip | 15251-6262
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Country | US
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Telephone | 346-980-2701
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Fax | 713-932-0437
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Authorized Official
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Title or Position | DIRECTOR REVENUE CYCLE
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Name | REBECCA RAGER
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Credential |
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Telephone | 844-969-0686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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