Provider Demographics
NPI:1245350388
Name:VASCULAR & ENDOVASCULAR SURGICAL CONSULTANTS OF ORLANDO PA
Entity type:Organization
Organization Name:VASCULAR & ENDOVASCULAR SURGICAL CONSULTANTS OF ORLANDO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:GARNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-363-7760
Mailing Address - Street 1:PO BOX 690998
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-0998
Mailing Address - Country:US
Mailing Address - Phone:407-363-7760
Mailing Address - Fax:407-363-7473
Practice Address - Street 1:7412 DOCS GROVE CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8010
Practice Address - Country:US
Practice Address - Phone:407-363-7760
Practice Address - Fax:407-363-7473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME900942086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7519622OtherAETNA
FL273603900Medicaid
FL37459OtherMEDICARE ID TYPE UNSPECIFIED
FL46022OtherBLUE CROSS & BLUE SHIELD
FL46022OtherBLUE CROSS & BLUE SHIELD