=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700119724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VOLUSIA-FLAGLER VASCULAR CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2009
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1873 N CLYDE MORRIS BLVD STE 101B
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32117-5638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-274-4244
-----------------------------------------------------
Fax | 386-274-4245
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3001 PALM HARBOR BLVD STE A
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34683-1930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-474-0090
-----------------------------------------------------
Fax | 727-474-0055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. VINAUAK V PURANDARE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 386-672-8595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------