Provider Demographics
NPI:1053668228
Name:LIFELINE VASCULAR CENTER OF SOUTH ORLANDO, LLC
Entity Type:Organization
Organization Name:LIFELINE VASCULAR CENTER OF SOUTH ORLANDO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HILGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-280-9501
Mailing Address - Street 1:3 W HAWTHORN PKWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1446
Mailing Address - Country:US
Mailing Address - Phone:847-388-2001
Mailing Address - Fax:847-388-2020
Practice Address - Street 1:1511 SLIGH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3959
Practice Address - Country:US
Practice Address - Phone:847-949-3845
Practice Address - Fax:866-408-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty