Provider Demographics
NPI:1619369998
Name:LA VIDA MEDICAL CENTER
Entity Type:Organization
Organization Name:LA VIDA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:FRANTZ
Authorized Official - Middle Name:
Authorized Official - Last Name:PHYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-432-8300
Mailing Address - Street 1:4519 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3449
Mailing Address - Country:US
Mailing Address - Phone:561-432-8300
Mailing Address - Fax:561-433-3026
Practice Address - Street 1:4519 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3449
Practice Address - Country:US
Practice Address - Phone:561-432-8300
Practice Address - Fax:561-433-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care