Provider Demographics
NPI:1821038084
Name:VASCULAR AND THORACIC SURGERY OF CENTRAL FLORIDA
Entity Type:Organization
Organization Name:VASCULAR AND THORACIC SURGERY OF CENTRAL FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-628-1300
Mailing Address - Street 1:180 S. KNOWLES AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-7009
Mailing Address - Country:US
Mailing Address - Phone:407-628-1300
Mailing Address - Fax:407-628-2788
Practice Address - Street 1:180 S KNOWLES AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7009
Practice Address - Country:US
Practice Address - Phone:407-628-1300
Practice Address - Fax:407-628-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40876208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068017600Medicaid
FL068017600Medicaid
FL1821038084Medicare PIN