Provider Demographics
NPI:1407093412
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:PHYSICIAN, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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
Mailing Address - Country:US
Mailing Address - Phone:561-439-0850
Mailing Address - Fax:561-439-0819
Practice Address - Street 1:2188 JOG ROAD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33415
Practice Address - Country:US
Practice Address - Phone:561-439-0850
Practice Address - Fax:561-439-0819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME84093Medicare PIN
FLG17368Medicare UPIN