Provider Demographics
NPI:1649509878
Name:VANTAGE HEALTH, LLC
Entity type:Organization
Organization Name:VANTAGE HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-861-2115
Mailing Address - Street 1:PO BOX 773730
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-3730
Mailing Address - Country:US
Mailing Address - Phone:352-861-2115
Mailing Address - Fax:352-854-5726
Practice Address - Street 1:9401 SW HIGHWAY 200 STE 502
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-9650
Practice Address - Country:US
Practice Address - Phone:352-671-4488
Practice Address - Fax:352-854-5726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty