Provider Demographics
NPI:1417208521
Name:LAS OLAS DE SEQUOIA LLC
Entity Type:Organization
Organization Name:LAS OLAS DE SEQUOIA LLC
Other - Org Name:LIFELINE VASCULAR CENTER - FT LAUDERDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HILGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-280-9501
Mailing Address - Street 1:3 W HAWTHORN PKWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1446
Mailing Address - Country:US
Mailing Address - Phone:847-388-2001
Mailing Address - Fax:847-388-2020
Practice Address - Street 1:6766 W SUNRISE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6072
Practice Address - Country:US
Practice Address - Phone:847-388-2001
Practice Address - Fax:847-388-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty