Provider Demographics
NPI:1225315484
Name:VIVERE-WINTER PARK FERTILITY LABORATORY LLC
Entity Type:Organization
Organization Name:VIVERE-WINTER PARK FERTILITY LABORATORY LLC
Other - Org Name:VIVERE-WINTER PARK FERTILITY LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-550-4913
Mailing Address - Street 1:720 COOL SPRINGS BLVD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2626
Mailing Address - Country:US
Mailing Address - Phone:615-550-4900
Mailing Address - Fax:615-550-4901
Practice Address - Street 1:5931 BRICK CT
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9304
Practice Address - Country:US
Practice Address - Phone:407-672-1106
Practice Address - Fax:407-678-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory