Provider Demographics
NPI:1134108327
Name:VISTA HEALTHPLAN OF SOUTH FLORIDA, INC.
Entity Type:Organization
Organization Name:VISTA HEALTHPLAN OF SOUTH FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF COMPLIANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:DARCEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:CHC
Authorized Official - Phone:954-965-3118
Mailing Address - Street 1:300 S PARK RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8593
Mailing Address - Country:US
Mailing Address - Phone:954-962-3008
Mailing Address - Fax:
Practice Address - Street 1:300 S PARK RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8593
Practice Address - Country:US
Practice Address - Phone:954-962-3008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL03-302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization