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General NPI Number Information
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NPI Number | 1649509878
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Entity Type | Organization
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Legal Business Name | VANTAGE HEALTH, LLC
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Dates
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Enumeration Date | 12/17/2009
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 9401 SW HIGHWAY 200 STE 502
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City | OCALA
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State | FL
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Zip | 34481-9650
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Country | US
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Telephone | 352-671-4488
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Fax | 352-854-5726
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Provider Business Mailing Address
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Address Line | PO BOX 773730
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City | OCALA
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State | FL
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Zip | 34477-3730
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Country | US
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Telephone | 352-861-2115
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Fax | 352-854-5726
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DONALD RUSSELL LOCKE
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Credential | MD
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Telephone | 352-861-2115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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