Provider Demographics
NPI:1457054074
Name:VMD PRIMARY PROVIDERS CENTRAL FLORIDA PLLC
Entity Type:Organization
Organization Name:VMD PRIMARY PROVIDERS CENTRAL FLORIDA PLLC
Other - Org Name:VILLAGE MEDICAL - PALM HARBOR
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-844-2271
Mailing Address - Street 1:PO BOX 360262
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-6262
Mailing Address - Country:US
Mailing Address - Phone:713-461-2915
Mailing Address - Fax:
Practice Address - Street 1:35553 US HIGHWAY 19 N STE 100
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1702
Practice Address - Country:US
Practice Address - Phone:727-766-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VMD PRIMARY PROVIDERS CENTRAL FLORIDA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-23
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty