Provider Demographics
NPI:1801140561
Name:VERIMED HEALTH GROUP SOUTH TAMPA LLC
Entity type:Organization
Organization Name:VERIMED HEALTH GROUP SOUTH TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLADYMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VRKIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-871-2959
Mailing Address - Street 1:2919 W SWANN AVE STE 400A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4082
Mailing Address - Country:US
Mailing Address - Phone:813-871-2959
Mailing Address - Fax:
Practice Address - Street 1:2919 W SWANN AVE STE 400A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4082
Practice Address - Country:US
Practice Address - Phone:813-871-2959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty