Provider Demographics
NPI:1245706423
Name:VARGAS MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:VARGAS MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-727-0984
Mailing Address - Street 1:4190 RICHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-6237
Mailing Address - Country:US
Mailing Address - Phone:321-727-0984
Mailing Address - Fax:321-727-3606
Practice Address - Street 1:606 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3227
Practice Address - Country:US
Practice Address - Phone:321-727-0984
Practice Address - Fax:321-727-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101937700Medicaid
FLDY8418OtherRRMEDICARE PTAN
FLKQ811OtherMEDICARE PTAN
FLRO9Q1OtherBCBS