MEDICARE: VANTAGE CLINICAL TRIALS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1100X	Research Clinic/Center

General Provider Information

NPI Number	:	1003603671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANTAGE CLINICAL TRIALS, INC.

Provider Business Mailing Address
First Line	:	1717 87TH TER N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33702-2148
Country	:	US
Telephone Number	:	727-510-9773
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 N HABANA AVE STE 300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-7148
Country	:	US
Telephone Number	:	813-549-5262
Fax Number	:	813-436-5461

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	CARLOS A BUSSEY
Credential	:
Telephone Number	:	727-510-9773

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	04/24/2025

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