Provider Demographics
NPI:1689948069
Name:VANGUARD MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:VANGUARD MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANDZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAPHNIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:352-243-9355
Mailing Address - Street 1:711 S HIGHWAY 27
Mailing Address - Street 2:SUITE E
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2791
Mailing Address - Country:US
Mailing Address - Phone:352-243-9355
Mailing Address - Fax:352-243-9334
Practice Address - Street 1:711 S HIGHWAY 27
Practice Address - Street 2:SUITE E
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2791
Practice Address - Country:US
Practice Address - Phone:352-243-9355
Practice Address - Fax:352-243-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP86471Medicare UPIN