Provider Demographics
NPI:1700119724
Name:VOLUSIA-FLAGLER VASCULAR CENTER LLC
Entity Type:Organization
Organization Name:VOLUSIA-FLAGLER VASCULAR CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINAUAK
Authorized Official - Middle Name:V
Authorized Official - Last Name:PURANDARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-672-8595
Mailing Address - Street 1:3001 PALM HARBOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1930
Mailing Address - Country:US
Mailing Address - Phone:727-474-0090
Mailing Address - Fax:727-474-0055
Practice Address - Street 1:1180 N WILLIAMSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-8176
Practice Address - Country:US
Practice Address - Phone:386-274-4244
Practice Address - Fax:386-274-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty