Provider Demographics
NPI:1083324883
Name:VIVAGEN HEALTH CORAL RIDGE
Entity Type:Organization
Organization Name:VIVAGEN HEALTH CORAL RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:PROF
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:954-440-6468
Mailing Address - Street 1:3200 N FEDERAL HWY
Mailing Address - Street 2:K5
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1066
Mailing Address - Country:US
Mailing Address - Phone:954-440-6468
Mailing Address - Fax:
Practice Address - Street 1:3200 N FEDERAL HWY
Practice Address - Street 2:K5
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1066
Practice Address - Country:US
Practice Address - Phone:954-440-6468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIVAGEN HEALTH URGENT CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-02
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty