Provider Demographics
NPI:1457824518
Name:VEDRE CARDIOVASCULAR CARE INC
Entity Type:Organization
Organization Name:VEDRE CARDIOVASCULAR CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMEETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VEDRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-738-0672
Mailing Address - Street 1:450 STATE ROAD 13 STE 106
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3863
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3599 UNIVERSITY BLVD S STE 400
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4232
Practice Address - Country:US
Practice Address - Phone:904-738-0672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008584500Medicaid