Provider Demographics
NPI:1770590804
Name:FLORIDA VASCULAR CONSULTANTS PA
Entity type:Organization
Organization Name:FLORIDA VASCULAR CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:G. KENDRIX
Authorized Official - Middle Name:
Authorized Official - Last Name:ADCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-539-2100
Mailing Address - Street 1:400 S MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5619
Mailing Address - Country:US
Mailing Address - Phone:407-539-2100
Mailing Address - Fax:407-539-1472
Practice Address - Street 1:400 S MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5619
Practice Address - Country:US
Practice Address - Phone:407-539-2100
Practice Address - Fax:407-539-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33431Medicare PIN