Provider Demographics
NPI:1811174113
Name:ULTROID WELLNESS CENTERS OF FLORIDA LLC
Entity type:Organization
Organization Name:ULTROID WELLNESS CENTERS OF FLORIDA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUTRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-898-0717
Mailing Address - Street 1:405 CENTRAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3843
Mailing Address - Country:US
Mailing Address - Phone:727-898-0717
Mailing Address - Fax:727-898-0716
Practice Address - Street 1:405 CENTRAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3843
Practice Address - Country:US
Practice Address - Phone:727-898-0717
Practice Address - Fax:727-898-0716
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ULTROID CLINICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-29
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty