Provider Demographics
NPI:1346561388
Name:VITAL CARE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:VITAL CARE MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNA
Authorized Official - Middle Name:SHIRLEY
Authorized Official - Last Name:GONALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-439-0850
Mailing Address - Street 1:2188 JOG ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-2188
Mailing Address - Country:US
Mailing Address - Phone:561-439-8050
Mailing Address - Fax:561-439-0819
Practice Address - Street 1:2188 JOG RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33415-6016
Practice Address - Country:US
Practice Address - Phone:561-439-8050
Practice Address - Fax:561-439-0819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6337208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty